With the acceleration of the aging of our country’s population, the disability of the elderly has gradually evolved into a new social risk. For this reason, socialized long-term care insurance was born as a new system of traditional elder service system reform. Through the comparative analysis of the two batches of long-term care insurance pilot regional policies in 2016 and 2020, the paper found that the four major systems of the pilot policy’s guarantee object, financing and payment, service supply, and supervision and management all present their own characteristics and problems. During “the Fourteenth-Five Plan”, it is necessary to optimize the development path in terms of expanding coverage and financing channels, improving the level of payment, the integration of medical and care, improving fund management, building a “nursing network” information system, and creating a technical standard system.