Important work happening at Milliman

Milliman LARA

Milliman Long-term care Advanced Risk Analytics (LARA®) is used to evaluate the relative risks of long-term care (LTC) claimants. Milliman LTC consultants find that claimants with lower LARA risk scores are more likely to recover from their claims than those with higher risk scores. Further, the highest risk scores are associated with an increased likelihood of persisting on claim until benefits are exhausted or dying while disabled.

LARA risk scores may be used in this way as a triage mechanism for LTC fraud programs or as an input into annual benefit eligibility certifications.

Irix Risk Score LTC

Irix Risk Score LTC is a new advanced predictive model that drops directly into the LTC underwriting workflow. Built on millions of life-years of LTC experience, the model uses real-world prescription histories and medical claims data to generate an LTC-specific risk score for the majority of applicants.

A simple numerical risk score is delivered at the point of review and enables underwriters to quickly distinguish clear accepts and declines while focusing attention on more-nuanced cases. By integrating seamlessly into accelerated underwriting processes, Irix Risk Score LTC helps improve efficiency, consistency, and decision speed—without compromising risk-selection discipline.

For LTC carriers, the result is a more targeted allocation of underwriting effort and a clearer, data-driven view of risk earlier in the process. For more information, you can visit Risk Score | LTC - Milliman IntelliScript.

Consulting

Our current LTC work spans the full lifecycle of the product: pricing new LTC designs; reviewing fraud, waste, and abuse governance and controls; projecting savings from wellness initiatives; supporting rate increase filings; and advising on rate increase strategy. Milliman consultants also support clients with valuations of LTC blocks for mergers and acquisitions (M&A).

LTC Guidelines work

The next iteration of the LTC Guidelines is well underway. Data processing is nearly complete, and we are beginning to refine assumptions through our predictive models. We remain on track for a 2027 release.

LTC pharmacy pipeline research

Our pharmacists, Hans Shaw, PharmD, and Kali Schweitzer, recently completed a client webinar on emerging drug therapies and implications for the LTC market. Please reach out to [email protected] if you would like a copy of the slide deck. Highlights include:

• Alzheimer's disease: New disease-modifying therapies show promise for early-stage patients, but broad LTC impact remains limited as most nursing home residents have progressed beyond eligibility criteria. The pipeline is active and worth monitoring for future claims implications.
• GLP-1 medications: The rapid expansion of GLP-1 utilization, projected to reach nearly 20 million weight-loss patients by 2030,¹ could positively impact LTC morbidity trajectories over time. The Centers for Medicare and Medicaid Services’s (CMS’s) Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) model and ongoing label expansions are worth monitoring closely.
• Fall risk and pharmacotherapy: Falls drive significant LTC admissions and mortality. High-risk medication classes, including antipsychotics, benzodiazepines, anticholinergics, and opioids, are highly modifiable risk factors. Structured pharmacy review programs represent a direct quality and cost management opportunity for LTC insurers and facility operators.

Industry news

Public reform update

Washington’s WA Cares Fund, the first public state-based LTC program in the country, will begin paying benefits on July 1, 2026, marking a major implementation milestone. The program also advanced at the end of 2025 with legislation allowing contributions to be invested in equities, and this year a workgroup was formed to evaluate policy options for late career workers moving into Washington.

Milliman continues detailed tracking of LTC legislative activity across states; if you would like a summary of updates from this tracking, please reach out to your Milliman consultant, and we will be happy to provide.

Annuity LTC

The market for annuities that include LTC insurance benefits picked up in 2025, with one new entrant according to LIMRA data. With an increase in interest rates over the past two years, annuity writers may seek product differentiation along other margins such as living benefits like LTC.

LTC riders to annuities serve further to provide stickiness to the product purchase and may improve persistency and revenues for both products.

Mergers and acquisitions

Earlier this month, Unum announced a second LTC reinsurance transaction, which will cede $3.8 billion in statutory reserves to Fortitude Re. Similar to Unum's 2025 reinsurance transaction, Fortitude Re is retroceding the biometric risk to a highly rated third-party reinsurer. This transaction continues the recent trend of M&A activity in the LTC industry.

Milliman publications and news

SOA LTC rate increase webinar

The Society of Actuaries (SOA) will host an upcoming webinar on LTC insurance rate increases, bringing together industry and regulatory perspectives. Courtney Kronlokken of Milliman’s Minneapolis Health Practice ([email protected]) will be presenting.

Experience studies with COVID-19 data

Milliman will be publishing an article soon that summarizes approaches for handling COVID-19 experience in LTC experience studies. Drawing on insights from recent experience studies, it will explore how COVID-19 experience impacted various assumptions and carriers differently. The article will summarize industry trends observed during and after the pandemic and examine approaches for treating COVID-19-era data in modern day applications using examples from predictive analytic-based experience studies.

CBUL/RBO experience studies

Another upcoming Milliman article will examine different methodologies for the treatment of contingent benefit upon lapse (CBUL) and reduced benefit option (RBO) policies in experience studies. This is an area that continues to evolve across the industry as the experience periods underlying assumption studies reflect continued rate increase activity. Drawing on insights from a recent survey, the article will highlight current approaches for handling CBUL and RBO in LTC experience studies and explore how they may evolve in the future.

The article will also explore ways of developing specific assumptions for CBUL, RBO, and adverse selection, including considerations around election rate drivers. By combining survey perspectives with broader industry observations, we aim to provide a practical view of current approaches and considerations for actuaries navigating these complexities.

LTC in Ireland

Milliman recently published a two-part paper focused on Ireland’s LTC system and the potential role of insurance in addressing future pressures.

Part 1 examines Ireland’s current LTC framework, centered on the state-supported Fair Deal scheme for nursing home care. The paper highlights pressures from population aging, limited bed capacity, and rising public expenditure. Using Irish demographic projections, it shows that demand for nursing home care could increase materially over coming decades, raising questions about affordability, infrastructure, and the sustainability of relying primarily on public funding.

Part 2 explores whether the insurance industry could play a complementary role in Ireland, drawing on examples from Germany, France, and the United States. It considers how LTC insurance or LTC-linked retirement solutions could help individuals manage Fair Deal copayments, protect household assets, and expand support for home care and community-based care.

If you would like additional information, please reach out to Seamus Glynn ([email protected]) or Kevin Manning ([email protected]).

Short-term care/Medicare Supplement article

Milliman expects to update in the second half of 2026 its 2021 SOA Health Watch article that highlights and demonstrates the potential packaging of short-term care and Medicare Supplement coverage in a product portfolio. This refreshed piece will examine how these products may complement one another, simultaneously offering broader protection for the policyholder while helping insurers manage their overall risk. The update will use practical examples to illustrate why pairing these coverages may be worth considering.

Keeping up with Milliman

SOA Health Meeting

Principal and Consulting Actuary Robert Eaton, from Milliman’s Tampa Health Practice, presented at the following sessions at the SOA Health Meeting in June 2026:

• A Superior Blend – Hybrid Group Life and Long-Term Care Combinations on a Group Insurance Platform
• AI for LTC Inforce Management – Early Warning Signals

If you are interested in the presentation content or discussing these topics with Robert, please reach out to him at [email protected] for more information.

SOA ValAct Meeting

Consulting Actuary Tyler Armstrong will present at the following session at the SOA ValAct Meeting:

• Tuesday, August 25 at 3:45 p.m.: The State of Long-Term Care Reserves

We hope to see you at ValAct in Denver!

Milliman in the community

Milliman Giving Fund

The Milliman Giving Fund continues to amplify Milliman’s mission by supporting transformative programs to improve communities’ health, education, and economic development worldwide. In 2025, the fund impacted almost 1 million people worldwide based on donations from Milliman employees and retired employees. Since 2019, the Giving Fund has donated more than $6 million to grantees worldwide. A copy of the 2025 Milliman Giving Fund Report can be found here.

Recently, the Milliman Giving Fund committed $1,050,000 over three years to Opportunity International to break cycles of generational poverty in Uganda and Colombia by driving economic development and job creation.² This three-year commitment builds on prior grants totaling $1.65 million, and it introduces two new innovations. It scales Opportunity's FarmerAI digital tools to Uganda for localized agricultural guidance and pilots a health model in Malawi to strengthen community health initiatives.

Since 2019, the Milliman Giving Fund has supported Opportunity International’s efforts to expand access to financial services, business training, and quality education—first in Mityana, Uganda, and then Cartagena, Colombia. At the heart of this collaboration is the creation of Opportunity Zones—specific geographic areas where Opportunity International offers its full suite of interventions.

Please reach out to a Milliman consultant to discuss any of these topics or other related items that interest you.

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¹ J.P.Morgan. (February 27, 2026). How demand for (and supply of) weight loss drugs is playing out in 2026. Retrieved July 8, 2026, from https://www.jpmorgan.com/insights/global-research/current-events/obesity-drugs.

² BusinessWire. (May 28, 2026). Milliman Giving Fund renews commitment to Opportunity International to accelerate global impact. Retrieved July 8, 2026, from https://www.businesswire.com/news/home/20260528762466/en/Milliman-Giving-Fund-renews-commitment-to-Opportunity-International-to-accelerate-global-impact.