Updated October 19, 2026. Quick answer: Box 4 of Form 1099-LTC may show that the benefits came from a qualified long-term care insurance contract, and box 5 may show that the insured was certified chronically ill or terminally ill, with the latest date certified. Both boxes are optional for the payer. The payer’s instructions define each term the boxes use.
What boxes 4 and 5 report
Both boxes are marked optional on the form. The table gives the wording from the policyholder copy and from the payer’s instructions.
| Box | What the text says |
|---|---|
| Box 4, on the policyholder copy | “May show if the benefits were from a qualified long-term care insurance contract.” |
| Box 4, in the payer’s instructions | “Check the box to indicate whether long-term care insurance benefits are paid from a qualified long-term care insurance contract.” |
| Box 5, on the policyholder copy | “May show if the insured was certified chronically ill or terminally ill and the latest date certified.” |
| Box 5, in the payer’s instructions | “If the insured was neither chronically nor terminally ill, leave this box blank.” |
Notice the word may in both recipient descriptions. A payer is not required to fill either box, so an empty box 4 or box 5 does not by itself tell you the contract was not qualified or that the insured was not ill. The overview of every box is in the Form 1099-LTC boxes guide, and the dollar boxes are in Form 1099-LTC boxes 1 and 2.
What a qualified long-term care insurance contract is
Box 4 depends on a definition in the payer’s instructions. “A contract issued after 1996 is a qualified long-term care insurance contract if it meets the requirements of section 7702B, including the requirement that the insured must be a chronically ill individual”
A second sentence covers older contracts: “A contract issued before 1997 is generally treated as a qualified long-term care insurance contract if it met state law requirements for long-term care insurance contracts and it has not been materially changed.”
The Form 8853 instructions state the general rule for such a contract: “In general, amounts paid under a qualified LTC insurance contract are excluded from your income.” That sentence is why a qualified contract matters to the person reading the form, and why box 4 is useful to see. The payments themselves are in boxes 1 and 2, and whether they were per diem is in Form 1099-LTC box 3.
What chronically ill means
Box 5 uses two terms. The payer’s instructions define the first: “A chronically ill individual is someone who has been certified (at least annually) by a licensed health care practitioner as” meeting one of two descriptions. One description reaches an individual who is unable to perform daily living activities and the instructions state it as “at least 90 days due to a loss of functional capacity”. The other reads: “Requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.”
The first description lists the activities that count. “Being unable to perform at least two activities of daily living (eating, toileting, transferring, bathing, dressing, and continence), without substantial assistance from another individual, for at least 90 days, due to a loss of functional capacity” That is the Form 8853 instructions’ wording of the same test. Note who does the certifying: a licensed health care practitioner, at least annually.
What terminally ill means
The second term is defined in the same place. “A terminally ill individual is someone who has been certified by a physician as having an illness or physical condition that can reasonably be expected to result in death in 24 months or less after the date of certification.”
The certifier here is a physician, not a licensed health care practitioner, and the window is stated as 24 months or less from the date of certification. The policyholder copy uses the same split when it describes how the benefits arise. “A life insurance company or viatical settlement provider may pay accelerated death benefits if the insured has been certified either by a physician as terminally ill or by a licensed health care practitioner as chronically ill.”
What the date certified is
The payer’s instructions tell the payer what to enter in box 5. “Check the box to indicate whether the insured was chronically or terminally ill.” “Also, enter the latest date certified.” The instruction asks for the latest date certified. If the date looks wrong or is missing, the payer named at the top of the form is the one to ask.
Where it goes on the return
Boxes 4 and 5 do not carry a dollar amount. They give context for the amounts in boxes 1 and 2. The policyholder copy says “See Pub. 525 and Form 8853 and its instructions for more information.” The Form 8853 instructions also separate the two certified conditions when they describe which accelerated death benefits to include: “Include only amounts you received while the insured was a chronically ill individual.” “Don’t include amounts you received while the insured was a terminally ill individual.” For background on long-term care insurance generally, see does Medicare cover long-term care.
Edition and box numbers
This page reads Form 1099-LTC (Rev. April 2025) and the Instructions for Form 1099-LTC (Rev. April 2025), the current files irs.gov served on 2026-10-19. The filer instructions carry this line: “Use these instructions for tax year 2025 and subsequent years until a superseding revision is issued.” The Form 8853 passages come from the 2025 Instructions for Form 8853. Check the year and edition printed on the form you received before relying on any box description here, because box numbers can change between editions.
Common mistakes
- Reading an empty box 4 as proof that the contract was not qualified. The form says box 4 “May show if the benefits were from a qualified long-term care insurance contract.”
- Using one certifier for both conditions. The instructions say a chronically ill individual is certified “by a licensed health care practitioner” while a terminally ill individual is certified “by a physician”.
- Treating the date in box 5 as the first date of illness. The instructions tell the payer to “enter the latest date certified.”
Related: does Medicare cover long-term care.
Sources
- Form 1099-LTC, Long-Term Care and Accelerated Death Benefits (Rev. April 2025), with Instructions for Policyholder and Insured: https://www.irs.gov/pub/irs-pdf/f1099ltc.pdf
- Instructions for Form 1099-LTC (Rev. April 2025): https://www.irs.gov/pub/irs-pdf/i1099ltc.pdf
- 2025 Instructions for Form 8853, Archer MSAs and Long-Term Care Insurance Contracts: https://www.irs.gov/pub/irs-pdf/i8853.pdf
- IRS: About Form 1099-LTC: https://www.irs.gov/forms-pubs/about-form-1099-ltc
Read from the IRS documents linked above on October 19, 2026. General information, not tax advice. Your own facts decide the outcome, and a preparer, the account provider or the IRS is the right place to confirm anything consequential.