Objective: The purpose of this study was to explore the current status of middle-aged and elderly residents' cognition of long-term care insurance, and analyze the factors affecting their cognition, in order to provide a reference for improving the penetration rate and participation rate of long-term care insurance. Methods: A questionnaire survey was conducted among eligible middle-aged and elderly residents in Tonglu County, Zhejiang Province by convenient sampling method. A total of 514 valid questionnaires were collected. χ² test and multiple logistic regression analysis were used to study the factors influencing residents' cognition of long-term care insurance system. Results: The study found that male residents with average self-rated health status had higher awareness of long-term care insurance. Freelancers have a lower awareness of long-term care insurance than other occupational groups. Monthly income has a significant positive effect on the awareness rate. Urban residents, staff of the Party and government agencies, employees of enterprises and self-employed people have higher recognition of long-term care insurance. Respondents with a bachelor's degree or above are generally at an average level of awareness and recognition of long-term care insurance. Conclusion: Gender, household registration, monthly income, occupation type and health self-assessment are the main factors affecting the cognition of long-term care insurance. It is suggested that measures such as increasing publicity, improving supervision mechanism, optimizing insurance payment conditions and forms, and establishing training and incentive mechanism of long-term care insurance personnel should be taken to improve residents' cognition of long-term care insurance.