Long-Term Care in Israel: The Two State Systems an Oleh Meets

Israel runs two state long-term-care systems, not one, and a newcomer meets both on terms a lifelong Israeli never does. Bituach Leumi (National Insurance) pays for care at home from retirement age. The Ministry of Health funds nursing-home care and bills the family back. Both means tests read your foreign pension, one of them reads your children's address, and the first thing to unlearn is the single-agency assumption you arrived with.

> This is general information, not tax, legal, or financial advice. Cross-border (US/UK) and Israeli tax interact in complex ways, so consult a qualified cross-border professional before acting.

Five things on this page are newcomer-specific, and they are its spine. Entitlement to the state benefit turns on residency plus the route you arrived by, not on citizenship. There is no qualifying period on this benefit, which only stands out once you have been turned away from others for want of accrued months. Both means tests reach into foreign pensions, and one defines income widely enough to catch a rente by name. The nursing-home co-payment is assessed on adult children from 21 who reside in Israel, which splits oleh families along a line drawn years earlier by who came and who stayed. And two carve-outs written for people with European histories sit inside systems most newcomers never read to the end.

Does Israel have one long-term-care system, or two?

Two, with different owners, different triggers and different means tests. Bituach Leumi's long-term care benefit is for people who reached retirement age, live at home, and need help from another person with daily activities or presence and close supervision ¹. Institutional care is the Ministry of Health's job, funded under the Third Addendum to the National Health Insurance Law, 5754-1994 ²⁰, under which geriatric hospitalisation is provided with the participation of the patient and their family in the cost ³.

The seam is written into the benefit's fourth condition. You are entitled while living at home or in sheltered housing, and not while staying in a long-term care division, a mentally-frail division, a prolonged respiratory division or a Ministry of Health rehabilitation institution, or where a public body funds most of your maintenance ¹. Institutional does not automatically mean excluded: a Ministry of Welfare licensed department for frail or independent persons still qualifies, and so does a Welfare-supervised institution where you bear most of the maintenance yourself ¹. A recipient who enters a general hospital keeps the benefit for the first 30 days only ¹. A fifth condition bars stacking state benefits: if you receive an attendance allowance for severe disability, a Treasury benefit for personal care or supervision, or the Ministry of Defense's help-from-others or accompaniment advantage, you must choose between that and this ¹. One Ministry of Defense payment is expressly outside that choice, and it is worth knowing before you surrender anything: a special needs increment may be held together with the long-term care benefit ¹.

There is no double-dipping across statutes either. Under the National Health Insurance Law a person is not entitled to Ministry of Health help with institutional care if entitled to that service under another law, which is how road-accident victims land with the motor insurer and work-accident victims with Bituach Leumi ¹⁷. And the word "code" is literal: assistance depends on a free budget slot existing within the nursing-hospitalisation quota set in that year's state budget ³.

Which ward you need decides who funds it, and one row below names a ministry a lifelong Israeli has no dealings with.

Each ward type carries its own licence from the Ministry of Health or the Ministry of Welfare, and the Ministry maps ward type to required licence alongside the flat statement that hospitalization in an institution without a license is dangerous ⁵. Ask to see the licence before you sign anything, which is worth doing slowly if you cannot yet read the Hebrew on it. Do not treat a hired caregiver as a substitute for a ward: the Ministry's own wording is that a nursing caregiver is not a medical professional and is not an alternative for nursing hospitalization ⁵.

One piece of housekeeping is worth doing years before any of this becomes urgent. The institutional file is opened at the Health Bureau for the address on your teudat zehut (national ID) ¹⁶, not the address you actually live at, and a first-year oleh address that never got updated will send the application to the wrong district office. Update the card's address appendix when you move.

What does Bituach Leumi's long-term care benefit actually pay?

Hours of care at home, or cash, or a basket of services, on six levels set by dependency points.

Read the two right-hand columns on two different clocks. The hours and points schedule is published as of 1 April 2026 ⁶¹¹, and the caregiver cash ladder as of 1 January 2026 ⁴.

From Level 2 up the benefit is counted in care hours, each weekly hour worth NIS 248 a month as of 1 April 2026 ⁷¹¹; Level 1 is counted in service units worth NIS 310 each, or taken whole in cash at NIS 1,705 a month, both as of 1 April 2026 ⁶. Hours convert to cash on a ladder that widens with the level: four weekly hours are worth NIS 992 a month at every level from 2 up ⁷¹¹, and the larger exchange runs to 6 hours at Level 3 (NIS 1,488), 7 at Level 4 (NIS 1,736), 9 at Level 5 (NIS 2,232) and 10 at Level 6 (NIS 2,480), each of those conditional on review and approval by a National Insurance social worker ⁸⁹¹⁰¹¹. Instead of hours you can take services: a day-care centre, Kehila Tomechet (supportive community) membership, absorbent products, a panic button, laundry ⁸. The income test does not trim the benefit, it halves it: a recipient of a reduced benefit due to income is entitled to a half benefit in every option they select ⁸.

There is a supplement written for people who arrived with a European history. A Holocaust survivor recognised as persecuted by the Holocaust Survivors Rights Authority, the Claims Committee, or under the West German Federal Indemnification Law (BEG), and entitled to a long-term care benefit, receives supplementary care hours or cash from the Holocaust Survivors' Rights Authority or the Claims Conference on top of what National Insurance pays ¹³. At 6 dependency points or more on a full benefit that is 9 additional care hours where the programme is personal home care hours, or a monthly bank payment where it is other services ¹³. It also reaches people the main benefit does not: at 1.5 or 2 points, where no long-term care benefit is payable at all, the payment is worth 2 weekly care hours, and since one weekly care hour is worth NIS 248 a month as of 1 April 2026, that is NIS 496 a month ¹³.

Becoming a foreign caregiver's employer is a real obligation. You must declare and pay insurance contributions on the whole salary paid, even when receiving no National Insurance benefit, and since August 2022 report the worker's personal details regardless of the wage ⁴. The Ministry of Health puts the contribution at premiums of up to 2 percent on the wages paid, and notes that a live-in foreign worker is paid for full-time work including overtime, holiday pay and sick leave ¹⁸. The employment permit belongs to the Population and Immigration Authority, not to Bituach Leumi, and over the age of 90 there is automatic eligibility for hiring a foreign worker ¹⁸. The full allowance for a close caregiver requires employment of at least 12 hours a day, 6 days a week, under a written contract, with wages ¹⁸.

One point lands harder on a newcomer than on a native. The Ministry of Health warns that foreign caregivers often do not speak Hebrew and that the resulting communication difficulty can affect an older person's wellbeing, suggesting you look for a caregiver who shares the language the person actually speaks ¹⁸. In an oleh household the older person's Hebrew is often the newest thing in it, so the language you match on may be English, French or Russian.

Do you have to wait after aliyah to claim it?

No. Bituach Leumi's own New Olim page states that a new oleh in a nursing condition may be entitled to a long-term care benefit immediately upon his aliyah, and that entitlement will start as of the eighth day ². That is what the page says, in its own words; treat it as the start-date rule as published rather than as a concession negotiated for olim.

The first condition carries a second newcomer carve-in. Normally the claimant must be an Israeli resident who has reached retirement age, which someone who became a resident only after retirement age would fail. Bituach Leumi writes them back in: where Israeli resident status was given only after reaching retirement age, you may still be entitled if you did aliyah under the Law of Return or received an immigrant absorption basket (Sal Klita) from the Ministry of Aliyah and Integration ¹. The gate is residency plus an aliyah route, not citizenship.

This is the exception, not the rule, for a newcomer's Bituach Leumi file. Most other benefits are gated by accrued qualifying months, covered in Bituach Leumi qualifying periods for olim, alongside what your Bituach Leumi coverage actually includes. This benefit begins at retirement age, so an oleh who becomes care-dependent at 55 is in a different track entirely: see the disability allowance for olim and income protection, and for a lump sum on diagnosis, critical illness cover.

Note the asymmetry before you plan around it. The state benefit has no qualifying period and can begin days after you land ², while long-term care insurance (bituach siudi) bought through a health fund runs a pre-existing-condition exclusion of one year, or six months where the insured was 65 or over when the insurance period began ¹⁹. Arriving already care-dependent is a case the state route contemplates and the private layer does not.

Israeli side: why is your foreign pension inside the income test?

Because the claim form asks for it and the test counts it. Bituach Leumi's New Olim page states that to receive the benefit you must fill out a claim and attach information about abroad income and medical documentation ². The test then counts, gross, income from work, income from pension, National Insurance benefits such as old-age and general disability, income from a property, IDF disability allowances without the mobility increment, and any other income under section 2 of the Income Tax Ordinance ¹². Nothing in that list distinguishes an Israeli pension from a foreign one.

There is a quiet reason the paperwork lands differently on you. The claim asks for income confirmations covering three months within the last four, and excepts from that requirement National Insurance allowances, retirement pension and Holocaust-survivor allowances ¹⁴. Whatever the reason for those exceptions, the New Olim page adds a requirement the general claim page does not carry: an oleh's claim must attach information about income from abroad ². So the paperwork an Israeli claimant is spared is not the paperwork you are spared, and the document Bituach Leumi wants from you is the one no Israeli office issues.

The thresholds are tested on your income and your spouse's in the three months preceding the claim. As of 1 April 2026, a single person receives the full benefit up to NIS 13,769, a benefit reduced by 50% over NIS 13,769 and up to NIS 20,654, and nothing above NIS 20,654; a couple receives the full benefit up to NIS 20,654, half between NIS 20,654 and NIS 30,980, and nothing above NIS 30,980 ¹. When both spouses need long-term care, the couple's income is combined, divided by two, and each assessed as a single person on that half ¹. Some income is excluded, and one exclusion matters later on this page: income from a private nursing insurance is not counted, and neither are allowances to victims of Nazi persecution or Holocaust survivors, mobility and attendance benefits, or polio and ringworm compensation ¹². Court-ordered maintenance is deducted, so are maintenance expenses for a spouse in a nursing institution, and rent you pay as a tenant is netted against rent you receive as a landlord ¹². One deduction is worth knowing if you kept a flat abroad or in Israel and moved into assisted living: the assisted-living component of what you pay is set against the rent you receive, and where the assisted-living cost is the larger of the two, the rental income drops out of the calculation entirely ¹².

One trap is specific to people who read only English. Bituach Leumi's English income-detail page still shows thresholds of NIS 13,467, NIS 20,201 and NIS 30,301, with an unrendered placeholder where the effective date should be ¹², while the conditions-of-entitlement page shows NIS 13,769, NIS 20,654 and NIS 30,980 stamped as of 1 April 2026 ¹. The gaps are NIS 302, NIS 453 and NIS 679, enough to move a household from full benefit to half. Work from the dated table. A worked example printed on the conditions page itself says an individual may earn up to NIS 12,796 and still be entitled, contradicting the table directly above it ¹, so read the table rather than the illustration.

Home-country side: what does your old system do for care in Israel?

Your foreign retirement income follows you into both Israeli means tests, while your home country's long-term-care arrangements almost certainly do not follow you at all. What can be said with a primary source behind it is narrow, so here is exactly that, by origin.

United States. A US Social Security payment and a US private pension are pension income for the Israeli test and are documented on the claim, because an oleh's claim must attach information about income from abroad ²¹². Whether a US long-term-care policy bought before aliyah pays for care delivered in Israel is a territorial-clause question inside your own contract; read the clause and ask the insurer for an answer in writing before you rely on it.

United Kingdom. A UK State Pension and a UK occupational pension are treated the same way by the Israeli test, gross, as pension income ¹². UK olim generally end home-country obligations through residence rules, so the US-only cross-border warnings later on this page do not apply to you.

Canada. Canadian public and workplace pensions land in the same category ¹², and Canadian olim likewise typically break home-country tax obligations through residence rules rather than by citizenship.

France and other European origins. A French pension counts as pension income for the Bituach Leumi test ¹². On the Ministry of Health side a rente is not a borderline case: Circular 8/2018 defines current income as any income, from any source, paid regularly, expressly listing a National Insurance allowance, any other allowance or benefit, salary, maintenance, pension, rente, insurance payouts other than long-term-care insurance, compensation and income from real estate ³. The circular's own document checklist asks the patient and spouse for an up-to-date confirmation of pensions, allowances and rentes ³, and the Ministry's calculator asks families to prepare information on income from abroad, naming a pension and other payments such as a rente ¹⁵. The default, then, is that it counts. The exclusions are narrow and specific: the monthly allowance and annual grant under section 8A of the Holocaust Survivors Benefits Law, 5767-2007, payments under the ringworm and polio compensation laws, allowances paid to the spouse personally for a health condition or disability, rent-subsidy assistance from another government ministry, and income a statute expressly says is not income for compulsory payments or taxes ³. Whether a particular reparations payment falls inside section 8A is the question to take, named, to the Department of Chronic Diseases at your Lishkat HaBriut (Health Bureau).

That rent-subsidy line is not incidental for a newcomer. Housing assistance paid to olim by another ministry is money the co-payment calculation is told not to treat as current income ³, which is the opposite of the usual assumption that any regular payment from the state counts against you.

If you kept property or an account abroad. Circular 8/2018 establishes real-estate ownership through Israeli registries, the Tabu, the Israel Land Authority, the Civil Administration and housing companies, then adds that rights may also be established by agreement, court decision or any other law, a clause with no geography in it ³; the calculator asks for income from renting properties without naming one either ¹⁵. Two related rules matter before you plan around a flat in London or Toronto: rent or its assessed value is added only where no spouse or dependants live in the property, and a property transferred to a relative without consideration less than five years before the application makes that relative's undertaking to pay its rental value a condition of the hospitalisation ³. Financial assets are defined by nature rather than location as moneys belonging to a person, available and not available for immediate use but realisable, with savings, kupot gemel (provident funds), deposits and one-time insurance payouts as examples ³. A foreign retirement account that can be cashed sits close to that wording, so take the specific property or account to the Health Bureau instead of guessing.

If the person needing care never made aliyah and is still abroad, this page is the wrong one: supporting parents abroad covers that, and benefits for olim who arrive past retirement age covers arriving late in life more generally.

Treaty side: can a social-security convention fix any of this?

Not in the way people hope, and it is worth seeing why before you wait for one. A totalisation arrangement exists to aggregate contribution months across two countries, and this benefit has no contribution months to aggregate: Bituach Leumi says a new oleh in a nursing condition may be entitled immediately upon aliyah, with entitlement starting as of the eighth day ². What the benefit tests instead is Israeli residency plus retirement age, with the Law of Return and absorption-basket carve-in for people who became residents later ¹, and income ¹². The Ministry of Health route runs on the National Health Insurance Law and a family means test rather than on a contribution record at all ³²⁰.

For American olim there is nothing to coordinate with in any case: Israel does not appear on the Social Security Administration's list of countries with which the United States has concluded a totalization agreement, which runs from Italy in 1978 to Iceland in 2019 ²¹. That is the same gap that blocks credit aggregation for a US retirement benefit, covered in reaching forty US Social Security credits. If your home country does have a bilateral social-security convention with Israel, whether it touches long-term care is a question for the text of that convention, and nothing on this page answers it. What is on this page is that residency in Israel, not contribution history, is what opens both Israeli routes.

Who pays for a nursing home, and how is the co-payment set?

The Ministry of Health pays the institution directly for the full cost of the stay and then collects a co-payment (hishtatfut atzmit) from the patient and family, under the National Health Insurance Law and by income tests ³. The monthly co-payment shall not fall below 37% of the individual old-age pension, and the ceiling is the full cost the Ministry actually pays the institution for the stay, which the circular's own definition fixes as a monthly figure updated by the Ministry's agreements with the institutions ³.

The order in which money is taken is fixed, and each source is reached only after the one before it is exhausted: the current income of the patient and spouse, then their current income from real-estate assets, then their financial assets, and only then the current income of the patient's adult children ³. Children are the last resort, not the first.

The process runs in two stages through the Department of Chronic Diseases at the Lishkat HaBriut for the address on your teudat zehut. In stage one a nurse visits the home within 14 working days of the application, sometimes with a social worker, and a geriatric committee classifies the patient within 10 working days of the file being completed ¹⁶. In stage two, once the financial documents are in, the co-payment sums for the patient, the spouse and each adult child are calculated within 13 working days, everyone liable signs a letter of financial commitment at the local health unit, and payment runs by standing order charged by the 24th of each month for the previous month ¹⁶. Budget for one step that surprises people who have not dealt with Israeli bureaucracy before: the declarative questionnaire each family member fills in has to be signed and certified by a lawyer ³. The Ministry's Kol Ha'Briut call centre takes questions and documents on *5400 or by email to call.habriut@moh.gov.il ¹⁶, and the Ministry's older-adults portal also publishes 08-6241010 for the same centre ¹⁸.

The family is not stripped bare. The patient keeps pocket money calculated under section 307 of the National Insurance Law and the pension-division regulations ³. A spouse who stays at home is left, as far as the couple's income stretches, a published list of items that includes the patient's pocket money, the health tax the couple owes, the spouse's own old-age pension, the value of 18 credit points, the full amount of any allowance paid to the spouse personally for a health condition or disability, the rent or mortgage on the home the spouse stays in, the municipal taxes on it, the premium for the spouse's supplementary health insurance, home help worth 3 credit points a month, half a credit point for telephone costs, and 9 credit points for each dependent family member with no income of their own ³. Two of those lines matter more to an oleh household than to a native one, because a newcomer is likelier to be renting than sitting in a long-held owned flat: the rent and the arnona (municipal property tax) come out before the co-payment is set. All of these protections are denominated in credit points, whose shekel value is updated annually, so read them as points rather than converting them.

Three things are worth memorising. A nursing home receiving Ministry funding must supply all the patient's needs, and it is prohibited to demand or collect any payments from patients or families receiving that assistance ¹⁶. Appeals run on two tracks: the bulletin sends appeals against the geriatric committee's classification or the co-payment calculation to the Public Health Unit ¹⁶, the circular gives each liable family member an appeal to a committee that decides on documents alone and may grant a discount expressed as a percentage of the sum set for that person ³, and the circular also records that under the National Health Insurance Law the route for appealing a decision made under this procedure is the Public Complaints Commissioner or the Labour Court ³. And the file does not stand still: recalculation is compulsory on the death of a spouse, and the Health Bureau may recalculate every two years or on request after a change in financial or family circumstances ³.

One exemption is written for a group made up disproportionately of people who came here from Europe. A patient recognised as Righteous Among the Nations by the Yad Vashem remembrance authority and living in Israel is completely exempt, together with every one of his family members, from paying any co-payment under this procedure, by force of section 3 of the Benefits for the Righteous Among the Nations Law, 5755-1995 ³.

Why does the nursing-home bill depend on where your adult children live?

Because the funding sources are limited to the current income of children from age 21 who reside in Israel ³. Circular 8/2018 puts it beyond doubt at section 3.1.3: an adult child of the patient who resides abroad will not be charged a co-payment ³. Section 3.1.1 says that where the patient has no adult children the Ministry of Health bears the remainder of the cost, and section 3.1.2 that where there are adult children, each is charged toward the parent's costs with a separate calculation per child ³.

For a native Israeli family, every child is in the calculation. For an oleh family, the answer depends on which children came. Parents who made aliyah alone, with three adult children who stayed abroad, face a means test that cannot reach any of them. Parents whose children all came face three separate calculations, three declarative questionnaires and three personal payment undertakings, with each child supplying ID copies and documents attesting to their steady incomes and expenses ¹⁶. Same parents, same illness, entirely different bill, decided by an immigration choice made years earlier.

What a liable child is actually charged is narrower than most families fear. The calculation takes the child's own average gross income over the last three months, deducts housing costs plus that child's marginal tax rate on them, divides by the size of the child's household, converts the result into credit points and reads it off a banded table whose first band, up to 6 credit points per person, is exempt ³. Household size is counted generously: a liable child with no spouse counts as three people, a child whose spouse has no income also counts as three, a child whose spouse has income counts as two, and each resident child adds one ³. Left out of that income are the income and financial assets of the child's own spouse, the child's own financial assets, child allowances, allowances paid for a health condition or disability, section 8A Holocaust survivor payments and private insurance payouts ³. Where both parents are institutionalised within twelve months, the child's participation is calculated once and charged once ³.

Refusing to sign is not a way out. A family member who refuses to sign the undertaking is charged the difference between what the other family members pay and what is actually paid to the institution, up to the full cost of the stay, and collection steps are taken ³. A patient is referred to an institution only after the patient and every liable family member have signed ³. The Ministry can enforce, because a debt for hospitalisation in a government hospital, or one whose fees the state guaranteed, is treated as a tax debt ³. And the co-payment keeps running while the patient is temporarily in a general hospital or on leave, unless the Ministry itself paid only a partial bed-reservation tariff, in which case the family's share falls by the same discount rate ³.

One question the circular does not answer is the most consequential for split oleh families. The words "residing abroad" appear exactly once in the forty-three pages, at section 3.1.3, with no definition of residence and no evidentiary standard for proving it ³. An adult child who holds Israeli citizenship and lives in New York is exactly the case that wording does not resolve. Raise it with the Health Bureau at stage two rather than assuming an answer in either direction.

### A worked example, with the arithmetic done

A couple made aliyah at 68 and 70. Their income is a US Social Security payment plus a small private pension, together NIS 19,800 a month, both documented because the claim requires information about income from abroad ² and pension income is counted gross ¹².

• NIS 19,800 is below the couple's full-benefit line of NIS 20,654 as of 1 April 2026, so a claim by one of them sits on the full benefit ¹.
• If both later need care, the incomes are combined and halved: NIS 19,800 divided by 2 is NIS 9,900 each, assessed as a single person, comfortably below the single full-benefit line of NIS 13,769 as of 1 April 2026 ¹.
• Had their income been NIS 22,000, they would sit between NIS 20,654 and NIS 30,980, and the benefit would be halved in whichever option they picked ¹⁸.
• One of them reaches Level 4, which is 21 care hours a week, or 18 where a foreign worker is employed ⁹. Taken as cash with a foreign caregiver, the state's maximum at Level 4 is NIS 4,464 a month as of 1 January 2026 ⁴, which is NIS 53,568 over twelve months. On the NIS 22,000 variant that maximum halves to NIS 2,232 a month, NIS 26,784 a year ⁴⁸.
• Two years later a nursing ward becomes necessary. The file moves to the Lishkat HaBriut, the Ministry pays the institution in full and bills back a co-payment that cannot fall below 37% of the individual old-age pension ³.
• Their three adult children are still in Chicago, so under section 3.1.3 none of them is charged ³. Because the Ministry pays the institution the full cost and collects only the co-payment it has assessed, the uncollected balance stays with the Ministry ³. Section 3.1.1 addresses the Ministry bearing the remainder where the patient has no adult children; the circular does not spell out in terms the case of adult children who all live abroad, so confirm it at stage two.
• Had all three made aliyah, each would have faced a separate calculation from age 21, on their own income after housing costs and divided by their own household size ³.

Does a private long-term-care payout reduce what the state gives you?

No, and this is confirmed in four independent places. Bituach Leumi excludes income from a private nursing insurance from its income test ¹². Circular 8/2018 excludes long-term care insurance payments from the patient's and spouse's current income, and private insurance payouts from a liable child's income ³. The Ministry of Health's funding-bodies sheet says long-term care insurance money can help the patient and family fund the cost of institutional care, including funding the co-payment for a patient whose hospitalisation is via the Ministry of Health ¹⁷. And from the insurance side, the group policy read for this page states that its benefits are paid in addition to and independently of any long-term-care benefit or service given by another body including the state, expressly including under the National Insurance Law, with the single exception of the institutional indemnity, which is capped against what you actually paid ¹⁹. A siudi payout does not cut the state benefit, does not raise the co-payment, and can be used to pay the co-payment.

How that layer pays is set by the group policy your health fund holds for its members. These policies are not freely drafted: each is written under the 2015 supervision directives on group long-term-care insurance for health fund members, a change in those directives changes the policy, and premium changes require the approval of the Commissioner of the Capital Market, Insurance and Savings Authority ¹⁹. In the 2025 policy year of the policy read here, the qualifying period is recorded as none, the waiting period from the insured event is 60 days with premiums still due during it, and the benefit runs for up to 60 months, counted cumulatively across every group policy you have ever claimed under ¹⁹. The trigger is inability to perform independently a material part, at least 50% of the action, of at least 4 of 6 daily activities (eating and drinking, getting up and lying down, dressing and undressing, bathing, sphincter control, mobility), or at least 3 where one is sphincter control, or a state of tshush nefesh determined by a relevant specialist ¹⁹. Two whole causes are carved out and sent back to the systems that own them: an event caused by a road accident, or by a work accident recognised by Bituach Leumi, is excluded from the policy altogether ¹⁹, which is the mirror image of the Ministry's own funder split ¹⁷.

Those amounts are from the 2025 policy year of that policy and are index-linked to the index published on 15 December 2023 ¹⁹, so ask your own fund for its booklet and its table rather than assuming these figures are yours. That table is the rule for anyone joining now; a separate transitional clause reads a different age into it for members who were already insured on 30 June 2016 and have stayed insured continuously since ¹⁹, which cannot include anyone who first joined a fund's group cover after mid-2016. The shape matters more than the shekels: caps fall as join age rises, institutional cover is an indemnity paid against receipts and tax invoices rather than a fixed cheque, and the home benefit is conditional on producing confirmation that you are helped by personal care for most hours of the day ¹⁹. If a family pays an institution NIS 5,000 a month privately and the insured first joined at 62, the 80% rule pays NIS 4,000, which sits under that band's NIS 4,500 ceiling.

Three widely repeated beliefs are wrong in ways that cost newcomers specifically. First, this cover is not guaranteed-issue, and an oleh correctly told that Israel cannot reject them for a pre-existing condition can carry that reassurance one product too far. The health basket and the fund's supplemental plan are the layers that cannot underwrite you, as insuring a pre-existing condition after aliyah sets out; the group long-term-care policy is a different animal, joined on a personal application including a health declaration, with a rejected applicant able to appeal to a joining-appeals committee within 60 days, and an applicant who supplies everything and hears nothing for 60 days insured automatically on ordinary terms ¹⁹.

Second, the door does not slam shut at 65. The policy's own benefit table carries a first-join band of 60 and over, so the gate is the underwriting decision rather than a birthday ¹⁹. What 65 changes is the length of the pre-existing-condition exclusion, and it shortens it: one year from the start of the insurance period for someone under 65 at that date, six months for someone aged 65 or more ¹⁹.

Third, changing health fund does not reset your cover. The band is fixed by your age at first joining a group long-term-care insurance for members of any health fund, counted from the point you have been continuously insured, including continuity preserved across a move between funds; a transferring insured's cover begins on the date the previous fund's cover ended, and joining needs no health declaration ¹⁹. The switching mechanics are in changing kupat cholim as an oleh, and the wider health-cover stack in private health insurance for olim. Premiums, and the group-versus-private cost comparison, are outside this page.

One caution before you assume the layers line up. The state assessment is a functioning capacity examination run by a Bituach Leumi assessor, from which dependency points are scored ¹⁴⁶, while the insurance trigger is assessed against the policy's own definitions and its own 50%-of-the-action threshold ¹⁹. Different bodies, different instruments. Qualifying for one does not decide the other.

What changes because of the passport you hold?

For US citizens and green-card holders the worldwide US filing obligation continues after aliyah, and three things here need saying out loud rather than leaving implied.

PFIC, addressed rather than waved away. One pooled Israeli vehicle does appear on this page. Circular 8/2018 gives kupot gemel as an example of a financial asset a family can be required to realise toward the co-payment ³, so a provident fund shows up here as something the means test can reach, never as something this page suggests holding. For a US-citizen oleh, holding a kupat gemel or any other non-US pooled fund is exactly where the US PFIC regime becomes the live question, and that question has its own page: the PFIC problem for US olim. Nothing in either Israeli long-term-care system changes that analysis in either direction, and nothing on this page should be read as advice to buy, hold or sell any pooled fund.

FBAR and FATCA are not triggered by anything on this page. Assembling foreign pension statements for an Israeli claim is a documentation exercise, not a US filing; the separate duty to report non-US financial accounts is covered in FATCA versus CRS for olim.

US tax on this money is out of scope, deliberately. Whether a long-term care insurance benefit is taxable on a US return, and whether nursing-home payments are deductible there, is not established by any source on this page, so it is not asserted here. That is a question for a cross-border professional.

UK, Canadian and South African olim generally end home-country obligations through residence rules, so the warnings in this section are not yours to carry.

On the Israeli side there is one small positive: the Ministry of Health notes that if a family member is in a nursing facility you may be eligible for an income tax credit, on your Israeli return ⁵. Do not read that across to a foreign return.

For guardianship, an enduring power of attorney and elder financial abuse, which sit alongside all of this once capacity is in question, see protecting an older oleh's finances.

What do you do this month, and who does it?

1. Bituach Leumi, the claim. Submit the long-term care benefit claim form with recent medical documentation (a medical-file digest, tests, treatments and medications, or a hospitalisation summary from the last three months) and income confirmations for you and your spouse covering three months within the last four; attach the custody order if a custodian signs, and a copy of the certificate of blindness if that applies ¹⁴. 2. Bituach Leumi, in English. The support centre is *9696 or 02-6709857, and volunteers of the Counselling Service to the Elderly will complete and submit the claim for you over the phone on *9696 ¹⁴. The dedicated English line is 02-6463404, answered Sunday to Thursday between 9:00 and 13:30, and there is an email address, 9696@nioi.gov.il, if you would rather write than talk ¹⁴. Once a claim exists, long-term care questions go to *2637 ⁴. 3. Gather the foreign paperwork first. Pension statements and benefit letters from your home country, because the oleh claim asks for information about income from abroad and no Israeli office will issue that document for you ²¹⁴. 4. Expect a phone assessment. An assessor schedules a call to check your functioning level, and you can ask for a home visit during that call; in specific cases entitlement is determined on medical documents alone, and from age 90 you may choose assessment by a geriatrician instead ¹⁴. 5. Holocaust Survivors Rights Authority or the Claims Conference. If the person needing care was recognised as persecuted by either, or under the West German BEG, check the additional-hours supplement, which is claimed separately from the National Insurance benefit ¹³. 6. Population and Immigration Authority. If a foreign caregiver is the plan, the employment permit runs through them, not through Bituach Leumi ¹⁸. 7. Lishkat HaBriut. If a nursing home is on the table, the application goes to the Department of Chronic Diseases at the Health Bureau for the address on your teudat zehut, with questions through Kol Ha'Briut on *5400 ¹⁶. 8. Misrad HaKlita. Keep the evidence of your aliyah route, under the Law of Return or the absorption basket, because condition one of the benefit turns on it ¹.

Your one action this week: ask your kupat cholim which group long-term-care policy you are on and what first-join date they have recorded for you, since that single date fixes your benefit band for as long as you stay continuously insured, and if the answer is that you are not on one, read insuring a pre-existing condition after aliyah before you assume you can join later.

Frequently asked questions

Israel runs two state long-term-care systems. Bituach Leumi pays for care at home from retirement age; the Ministry of Health funds nursing-home care and bills a co-payment. Both means tests count your foreign pension, and the nursing-home test reaches adult children from 21 who live in Israel, but only after the patient's own money runs out.