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Fillable Form 1099-LTC

Form 1099-LTC, "Long-Term Care and Accelerated Death Benefits," is the IRS form that enables individual taxpayers to report long-term care (LTC) benefits, including accelerated death benefits.

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What is Form 1099-LTC?

Form 1099-LTC, Long-Term Care and Accelerated Death Benefits, is used by taxpayers in the United States to report the payments they have made for the long-term care benefits of policyholders, insured persons, or third parties. Payers of long-term care benefits who must file Federal Tax Form 1099 LTC include insurance companies, governmental units, and viatical settlement providers. If a taxpayer is required to file Federal Tax Form 1099 LTC, he or she must furnish a statement or an acceptable substitute to both the policyholder and to the insured person.

The policyholder is the individual who owns the contract, including the owner of a contract sold or assigned to a viatical settlement provider. In the case of a group contract, the term policyholder includes the certificate holder. The taxpayer must then report long-term care benefits to the policyholder even if the payments were made to an insured person or to a third party. The policyholder may also be the insured person.

U.S. taxpayers will be able to report the benefits they have paid from each contract on a separate Form 1099-LTC. At their option, they may aggregate the benefits paid under multiple contracts on one Form 1099-LTC if the same information is reportable on the form for each contract other than the amount of benefits paid.

Long term benefits can be considered as the following:

  • Any payments a taxpayer in the United States may have made under a product that is advertised, marketed, or offered as long-term care insurance, whether it is qualified or not
  • Accelerated death benefits that are excludable as a whole or as part from a person’s gross income paid under a life insurance contract or paid by a viatical settlement provider

U.S. taxpayers are able to pay for the long-term care benefits of chronically ill or terminally ill individuals. A chronically ill individual is someone who has been annually certified by a licensed health care practitioner as:

  • Being unable to perform, without substantial assistance from another individual, at least two daily living activities such as eating, toileting, transferring, bathing, dressing, and continence for at least 90 days due to a loss of functional capacity
  • Requiring substantial supervision to protect the chronically ill individual from any threats to his or her health and safety due to severe cognitive impairment

On the other hand, an individual may be considered terminally ill if he or she has been certified by a physician as having an illness or physical condition that can reasonably be expected to result in his or her death in 24 months or less after the date of certification.

How to fill out Form 1099-LTC?

Get a copy of 1099-LTC template in PDF format.

Taxpayers in the United States can download and print a PDF copy of Federal Tax Form 1099 LTC from the Internal Revenue Service (IRS) website that they can manually complete. They can also fill out Federal Tax Form 1099 LTC electronically on PDFRun.

The 1099 LTC Tax Form has several copies. The following instructions below are applicable to all the copies:

  • Copy A - For Internal Revenue Service Center
    • This copy must be filed along with Form 1096, Annual Summary and Transmittal of U.S. Information Returns.
  • Copy 1 - For State Tax Department
  • Copy B - For Policyholder
    • If you are required to file a tax return, a negligence penalty or other sanction may be imposed on you if this item is required to be reported and the Internal Revenue Service (IRS) determines that it has not been reported.
  • Copy C - For Insured
    • Only the policyholder is required to report this information on a tax return.
  • Copy D - For Payer

To fill out the 1099 LTC Tax Form, you must provide the following information:

Payer’s Name

Enter your full legal name.

Payer’s Street Address

Enter your street address including your apartment number.

Payer’s City or Town

Enter your city or town.

Payer’s State or Province

Enter your state or province.

Payer’s Country

Enter your country.

Payer’s ZIP Code or Foreign Postal Code

Enter your ZIP code or foreign postal code.

Payer’s Telephone Number

Enter your telephone number.

Payer’s Tax Identification Number (TIN)

Enter your tax identification number (TIN).

Policyholder’s Tax Identification Number (TIN)

Have your policyholder enter his or her tax identification number (TIN).

Policyholder’s Name

Have your policyholder enter his or her full legal name.

Policyholder’s Street Address

Have your policyholder enter his or her street address including his or her apartment number.

Policyholder’s City or Town

Have your policyholder enter his or her city or town.

Policyholder’s State or Province

Have your policyholder enter his or her state or province.

Policyholder’s Country

Have your policyholder enter his or her country.

Policyholder’s ZIP Code or Foreign Postal Code

Have your policyholder enter his or her ZIP code or foreign postal code.

Policyholder’s Telephone Number

Have your policyholder enter his or her telephone number.

Policyholder’s Account Number

Have your policyholder enter his or her account number.

Calendar Year

Enter the calendar year for this federal tax form.

Box 1. Gross long-term care benefits paid

Enter all of the gross benefits you have paid under a long-term care insurance contract during the current tax year in U.S. dollars.

Box 2. Accelerated death benefits paid

Enter all of the gross accelerated death benefits you have paid during the current tax year in U.S. dollars.

Box 3. Per Diem or Reimbursed Amount

Mark the appropriate box which corresponds to the amount that has been applied in this form. You may select:

  • Per diem
  • Reimbursed amount


A per diem basis payment is the amount you have paid on any periodic basis without any regard to your actual expenses. On the other hand, a reimbursed basis payment is the amount you have paid for the actual expenses you have incurred.

For accelerated death benefits, you will not be required to mark any of the boxes if you have already made a payment on behalf of a terminally ill person.

Box 4. Qualified contract

Mark the box to indicate whether long-term care insurance benefits are paid from a qualified long-term care insurance contract.

Box 5.

Mark the box to indicate the insured person’s medical condition. You may select:

  • Chronically ill
  • Terminally ill

If the insured person was neither chronically nor terminally ill, you may leave the box blank.

Date certified

Enter the date of certification for the insured person’s medical condition.

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