Many Americans will develop health problems as they age and need assistance with everyday activities. Private long-term care insurance could protect them from high out-of-pocket costs if they need paid assistance at home or in nursing or assisted-living facilities. Yet, only 11 percent of adults ages 65 and older had coverage in 2014, including only 25 percent of those worth at least $1 million and who would benefit most from coverage. Various policy reforms could promote long-term care insurance, such as ones that create new incentives for employers to offer coverage through workplace retirement plans on an opt-out basis.