In recent years, several rapidly aging countries have looked towards the introduction of a national long-term care insurance (LTCI) policy to deal with the needs of their graying population. This article presents a comprehensive overview of the LTCI policy in Japan and the reforms made, and discusses the successes and challenges of the policy over the ten-year period since its implementation in April 2000. The objective is to provide some policy guidelines so that other countries can benefit from Japan’s early experience. All Japanese adults aged 65+ are covered by the LTCI program and are eligible for both in-home and institutional-care services after a systematic and thorough care-level certification process. The utilization of services is planned and coordinated by care managers. The program is financed by a mix of general tax revenues from the three levels of government, income-tested premiums, and standardized co-payments. Reforms in later years included the introduction of preventive services and the levy of charges on accommodation and meals at institutional facilities. A key success of the policy is its universal and comprehensive coverage. Notwithstanding this success, increasing costs continue to remain a challenge as Japan’s population ages further and the number of LTCI users increases.