The Most Important Insurance Nobody Talks About
When olim arrive in Israel, they focus on health insurance, pension, and maybe life insurance. But there is one type of coverage that most olim do not hear about until it is too late: ביטוח סיעודי (Bituach Siudi) (nursing care insurance, also called long-term care insurance).
This insurance pays a monthly benefit if you become unable to perform basic daily activities (ADLs) such as bathing, dressing, eating, or moving independently. With professional nursing care in Israel costing 15,000-25,000 NIS per month, and Bituach Leumi's nursing benefit covering only a fraction of that, the gap can devastate a family's finances.
What Bituach Leumi Covers (And What It Does Not)
ביטוח לאומי (Bituach Leumi) (National Insurance Institute) provides a basic nursing care benefit (Gimla Siudit) for people who meet certain dependency criteria. Here is what it actually covers:
- Home-care hours: Depending on dependency level, you receive 5.5 to 30 hours per week of home assistance (not nursing), or a cash-equivalent payment.
- Day care center: Access to adult day care centers for socialization and supervision.
- Absorbent products: Monthly supply of incontinence products.
- Emergency button: A personal alarm device.
What Bituach Leumi does NOT cover:
- 24/7 home nursing care (the biggest gap)
- Private nursing home fees (typically 12,000-22,000 NIS/month)
- Specialized dementia care
- Full-time caregiver salary (10,000-15,000 NIS/month for a foreign caregiver)
The Bituach Leumi nursing benefit is means-tested and covers only basic assistance. For anyone who develops a serious long-term care need, the benefit covers perhaps 30-40% of actual costs. The rest must come from personal savings or insurance.
Can you get a nursing plan through your Kupat Cholim?
Each of Israel's four health funds ( קופת חולים (Kupat Cholim)) offers a group nursing insurance plan as part of their supplemental insurance (Bituach Mashlim or the platinum tier). These group plans are significantly cheaper than private policies because risk is pooled across all members.
| Feature | Kupat Cholim Group Plan | Private Policy |
|---|---|---|
| Monthly cost (age 40) | 30-80 NIS | 150-400 NIS |
| Monthly cost (age 60) | 80-200 NIS | 400-1,200 NIS |
| Monthly benefit | 5,000-8,000 NIS | 8,000-20,000 NIS (customizable) |
| Waiting period | Typically 60-90 days | 60-180 days |
| Pre-existing conditions | Usually covered if enrolled early | May be excluded or priced higher |
| Portability | Lost if you switch Kupat Cholim | Stays with you |
| Insurer stability | Can change terms collectively | Individual contract, more stable |
Key consideration: Group plans can change their terms, premiums, and even coverage levels because they are collective agreements. Several Kupat Cholim funds have adjusted nursing insurance terms in recent years. Private policies offer more contractual certainty but at a higher cost. Which trade-off suits your family is easier to judge with the plans set out side by side.
By what age must you enroll in nursing insurance?
This is the critical point of this article. Nursing insurance has age-based enrollment restrictions:
- Under 50: Easy enrollment in both group and private plans, with the lowest premiums and broadest coverage.
- 50-59: Still enrollable but premiums are significantly higher and medical questionnaires may result in exclusions.
- 60-64: Very limited options. Some Kupat Cholim group plans still accept new members, but private insurers are reluctant. Premiums are steep.
- 65 and older: Essentially uninsurable for new policies. Once you pass this age without coverage, the window is closed permanently.
For olim specifically: If you make Aliyah after age 55, this is one of the most urgent financial actions you need to take. Do not wait for your Hebrew to improve or for life to settle down. Enroll in a Kupat Cholim group nursing plan within your first months. The supplemental insurance 90-day window may apply to the nursing component as well, depending on your health fund.
How Much Coverage Do You Need?
The goal is to bridge the gap between Bituach Leumi's benefit and the actual cost of care. A reasonable target:
- Home care with a full-time caregiver: 10,000-15,000 NIS/month. Bituach Leumi covers roughly 3,000-5,000 NIS equivalent. Gap: 7,000-10,000 NIS.
- Nursing home: 12,000-22,000 NIS/month. Bituach Leumi covers very little for institutional care. Gap: 10,000-20,000 NIS.
A policy paying 8,000-10,000 NIS/month is a reasonable middle ground for most families. Combined with Bituach Leumi benefits and some personal savings, this should cover most realistic scenarios.
How do you enroll in nursing insurance?
For the Kupat Cholim group plan:
- Visit your Kupat Cholim branch or call their customer service line. Ask specifically about the Bituach Siudi component of their supplemental insurance.
- If you are already enrolled in the supplemental plan (Mashlim), the nursing component may already be included. Verify this explicitly.
- If you need to add it separately, request enrollment forms. For most health funds, this can be done online or at the branch.
For a private policy:
- Contact an insurance agent (Sochen Bituach) who specializes in nursing insurance. Ask for quotes from at least three insurers.
- Expect a medical questionnaire. Be honest as misrepresentation can void the policy when you need it most.
- Compare: monthly benefit amount, waiting period, benefit duration (some policies cap at 3 or 5 years), and whether the benefit is inflation-linked. Our side-by-side comparison lines those figures up.
US comparison: Long-term care insurance in the US is notoriously expensive and increasingly hard to find, with premiums often running $2,000-5,000/year for coverage starting at age 55. Many Americans rely on Medicaid (after spending down assets) or self-insure. Israeli group plans through Kupat Cholim are dramatically cheaper and more accessible. If you gave up on LTC insurance in the US due to cost, you have a much better opportunity in Israel.
Medicare does not cover long-term care. Neither does most private health insurance in the US. Israel's Bituach Leumi provides at least a baseline of home-care hours, which is more than Medicare offers for ongoing nursing needs.
How do you weigh and compare a nursing plan?
Since the individual private market closed to new buyers in 2019, the practical choice today is no longer "which private policy to buy." It is how to make the most of the layers still open to you: the unified group nursing plan through your kupat cholim, which stays open to new members but, since December 2023, only at its basic tier for new joiners; protecting any older private policy a family member still holds; and self-funding the tail of care beyond the plan's five-year payout. This is a criteria list, not a company list: it teaches what to look at, while the named side-by-side comparison lives in Meidahon's comparison system. The first two criteria decide whether a plan pays at all and how much; the rest decide which route or insurer to choose.
What to weigh when choosing nursing (siudi) cover
- Monthly benefit amount and how long it paysThis is the heart of the cover. The group plan pays a fixed benefit for 60 months (five years) only, while older private policies sometimes paid for life. Check the benefit closes the gap against a realistic 15,000 to 25,000 shekel monthly cost of care, and never cancel an old lifetime-paying policy.
- The trigger: ADL test and definition severityA plan pays only once you cannot perform at least 3 of 6 basic daily activities (bathing, dressing, eating, mobility, continence, and moving from bed to chair), or on cognitive decline such as dementia. A stricter definition of care-dependent decides whether you are paid at all.
- Home care versus institutional careThe unified group plan pays a different monthly benefit for care at home than for a nursing institution, and the home-care figure is usually the lower of the two. Make sure the tier matches the way you are likely to be cared for.
- Premium level, escalation, and how firm the terms areGroup premiums are cheaper because risk is pooled, but a collective plan can change its premiums and terms at each contract period, and premiums that rise with age start low and climb. Joining younger locks in a lower rate, which matters most for olim arriving after 55.
- Age at entry and the closing windowThe younger you join the cheaper the premium and the easier the acceptance; from 60 to 64 options narrow, and at 65 and older new cover is essentially closed. Registering children early fixes an insurance continuity with no medical exclusions.
- Waiting (elimination) period before the first paymentThe group plan begins paying only 60 days after you are recognized as care-dependent, and private policies typically run 60 to 180 days. A longer wait means you need savings to cover those first months out of pocket.
- Insurer stability and the mutual-insurance riskA policy is only as good as the body that pays it years later. If a fund does not renew its group cover with an insurer, members move to a continuity (mutual-insurance) policy that takes no new joiners. Check the insurer solvency ratio and the Capital Market Authority service index.
Compare long-term care (nursing) cover in Israel
Monthly benefit and payout duration, the ADL trigger, home care versus institution, the waiting period, premium structure, and insurer stability, in Meidahon's independent side-by-side comparison.
See the comparison
Which situation is yours?
Bituach Siudi (nursing or long-term care insurance) pays a monthly benefit if you can no longer perform basic daily activities like bathing, dressing, eating, or moving on your own. It matters because full-time professional nursing care in Israel runs 15,000 to 25,000 NIS per month, while Bituach Leumi's Gimla Siudit benefit covers only 5.5 to 30 hours per week of home assistance plus basic supplies, roughly 30 to 40 percent of real costs. The cheapest route is a group plan through your Kupat Cholim (health fund): about 30 to 80 NIS per month at age 40 and 80 to 200 NIS at age 60, compared with 150 to 1,200 NIS for a comparable private policy. The deadline is the headline: enrollment gets harder from age 50, very limited from 60 to 64, and essentially closed at 65 and older. Olim who make Aliyah after age 55 should enroll in a Kupat Cholim group nursing plan within their first months in Israel, since the supplemental insurance 90-day window may apply to the nursing component depending on the fund. Group plans are cheaper but not portable (switching health fund resets coverage and the waiting period), while a private policy through a Sochen Bituach follows you between funds at higher cost.
Bituach Siudi, also called nursing care or long-term care insurance, pays a monthly benefit if you become unable to perform basic daily activities (ADLs) such as bathing, dressing, eating, or moving independently. Olim need it because professional nursing care in Israel costs 15,000 to 25,000 NIS per month, and Bituach Leumi's nursing benefit covers only a fraction of that. The gap between what the state covers and what care actually costs can devastate a family's finances, yet most olim do not hear about this coverage until it is too late.
Bituach Leumi's Gimla Siudit benefit is means-tested and provides only basic assistance. Depending on your dependency level, it covers 5.5 to 30 hours per week of home assistance (not nursing) or a cash-equivalent payment, access to adult day care centers, a monthly supply of incontinence products, and a personal emergency alarm button. It does NOT cover 24/7 home nursing care (the biggest gap), private nursing home fees (typically 12,000 to 22,000 NIS per month), specialized dementia care, or a full-time caregiver salary (10,000 to 15,000 NIS per month for a foreign caregiver). For anyone with a serious long-term care need, the benefit covers perhaps 30 to 40 percent of actual costs; the rest must come from personal savings or insurance.
Nursing insurance has age-based enrollment restrictions. Under 50, enrollment is easy in both group and private plans with the lowest premiums and broadest coverage. From 50 to 59 you can still enroll, but premiums are significantly higher and medical questionnaires may result in exclusions. From 60 to 64 options are very limited: some Kupat Cholim group plans still accept new members, but private insurers are reluctant and premiums are steep. At 65 and older you are essentially uninsurable for new policies, and once you pass this age without coverage the window closes permanently. If you make Aliyah after age 55, enrolling in a Kupat Cholim group nursing plan within your first months in Israel is one of the most urgent financial actions to take.
Group nursing plans through your Kupat Cholim are significantly cheaper than private policies because risk is pooled across all members. A group plan costs roughly 30 to 80 NIS per month at age 40 and 80 to 200 NIS per month at age 60, paying a monthly benefit of 5,000 to 8,000 NIS with a waiting period of typically 60 to 90 days. A comparable private policy costs 150 to 400 NIS at age 40 and 400 to 1,200 NIS at age 60, paying a customizable 8,000 to 20,000 NIS monthly benefit with a 60 to 180 day waiting period. Private policies cost roughly 3 to 6 times more and scale steeply by age.
The main trade-off is cost versus portability and certainty. Group plans through your health fund are far cheaper but are not portable: switching Kupat Cholim resets your coverage and triggers a new waiting period, and because they are collective agreements the fund can change terms, premiums, and even coverage levels (several funds have adjusted nursing terms in recent years). A private policy through a Sochen Bituach (insurance agent) follows you between funds, offers more contractual certainty as an individual contract, and may exclude pre-existing conditions or price them higher. Group plans usually cover pre-existing conditions if you enroll early.
The goal is to bridge the gap between Bituach Leumi's benefit and the real cost of care. For home care with a full-time caregiver costing 10,000 to 15,000 NIS per month, Bituach Leumi covers roughly 3,000 to 5,000 NIS equivalent, leaving a gap of 7,000 to 10,000 NIS. For a nursing home costing 12,000 to 22,000 NIS per month, Bituach Leumi covers very little for institutional care, leaving a gap of 10,000 to 20,000 NIS. A policy paying 8,000 to 10,000 NIS per month is a reasonable middle ground for most families, which combined with Bituach Leumi benefits and some personal savings should cover most realistic scenarios.
For a Kupat Cholim group plan, visit your health fund branch or call customer service and ask specifically about the Bituach Siudi component of their supplemental (Mashlim) insurance; if you already have the supplemental plan the nursing component may already be included, so verify it explicitly, and if not, request enrollment forms (often available online). For a private policy, contact a Sochen Bituach who specializes in nursing insurance, get quotes from at least three insurers, expect a medical questionnaire (be honest, since misrepresentation can void the policy), and compare benefit amount, waiting period, benefit duration, and inflation-linking. Compared to home countries, US long-term care insurance is expensive and hard to find (often $2,000 to $5,000 per year for coverage starting at 55) and Medicare does not cover long-term care, so Israeli group plans are dramatically cheaper and more accessible. In the UK, care is means-tested through local councils above a capital threshold of around 23,250 GBP with residential care averaging 800 to 1,000 GBP per week, whereas Israel provides a universal baseline through Bituach Leumi regardless of assets.
The Bottom Line
Nursing insurance is not exciting. It is not something you will use for decades, if ever. But for those who need it, the financial impact is devastating without coverage. The combination of Bituach Leumi benefits plus a Kupat Cholim group plan provides reasonable protection at a modest cost.
Your action item: Check whether your current Kupat Cholim supplemental plan includes nursing insurance. If not, add it. If you are over 55, do this within the next week, not the next month.