What is Long-term Care Insurance?




What is long-term care? 

Long-term care includes the care you need when you can no longer perform the day-to-day activities normally associated with independent living due to chronic illness, disability, disease or merely as a result of the frailties of aging. This includes performing everyday activities like bathing, dressing or eating. This assistance can be provided in your home, community, or at an assisted living facility or nursing home.


What is the likelihood that I will need long-term care? 

It’s likely that you or a family member will need long-term care at some point in your lifetime. Currently, it is estimated that, on average, a 65-year-old today has a 70 percent chance of needing some type of long-term care. [1] This could include both care from a paid provider or care from family or friends. Your chance of needing long-term care services are greater if you are older, are female, or possibly due to a family history of longevity or debilitating disorders. And, long-term care can be expensive. If you need care, the average lifetime expenditure of someone age 65 or older who needs long-term care is about $150,000. [2] In addition to this very real cost, families are also supplementing the care needs of their loved ones with everyday assistance. The need for long term care is not only limited to the elderly; it may be necessary for younger individuals who are debilitated by accidents, strokes or by degenerative diseases like Parkinson’s Disease, Multiple Sclerosis or others.


What is long-term care insurance? 

Long-term care insurance provides benefits to help you and your family manage the potentially significant costs of long-term care. It helps you to protect your financial assets so that you and your family will have the financial resources to pay for the care you may need and can focus on your life together instead of worrying about your finances. This takes the potential burden of care off of your family and gives you the peace of mind that you will be able to afford the type of care you need and choose. Long-term care insurance costs only a fraction of what it would cost you if you had to pay for your care needs completely on your own.


What kinds of illnesses does long-term care insurance cover? 

Long-term care insurance covers assistance that may be necessary due to aging, an accident or lengthy illness, chronic health conditions and/or physical disabilities, such as a stroke, Alzheimer’s disease, Multiple Sclerosis, or Parkinson’s.


What types of care can I receive with long-term care insurance? 

Long-term care insurance gives you the ability to choose the type of care you prefer. Plans can include coverage of home care, hospice care, respite care, adult day care, care in assisted living facilities and nursing homes and some plans may include coverage for some types of informal (family or non-professional) care. Some plans simply pay you a cash benefit for each day you are disabled so that you have total freedom to decide which services and providers you will use.


Am I covered for long-term care? 

Most long-term care services are NOT covered by any other kind of insurance, including health insurance, long-term disability insurance, Medicare, or Medicare supplemental coverage. Only long-term care insurance covers the type of day-to-day personal care assistance you might need if you were unable to care for yourself as a result of chronic illness, disability or disease. This type of care is known as personal or custodial care.


Most people incorrectly think Medicare will pay for long-term care services. In reality, Medicare does not generally cover long-term care. Medicare pays for skilled care in a nursing home only for the short period during which you are recuperating following a hospital stay (only up to 100 days). Once your care needs stabilize, and you need personal or custodial care, Medicare will not pay these costs. Medicare will only pay for care at home under very limited circumstances. Medicaid pays for long-term care only for seniors with very low incomes. Please visit the Medicare and Medicaid Long-term Care Web site for more detailed information on what Medicare covers.


What does long-term care cost? 

Long-term care can be expensive. The national average cost of one year in a nursing home is over $75,000.[3] A year of care at home, on average nationally, can cost $40,000.[4] The total cost of care can be even higher depending on the area of the country where care is received, the length of stay or hours of care for home care, and the type of care needed. These costs can be a financial hardship without the benefit of long-term care insurance.


In addition to financial costs of care, there is also an emotional cost on family and friends as they struggle to support and assist a loved one who needs care. The enormous emotional stress that you and your family may experience caring for a loved one can be significant. While family may be willing to provide the care that is needed, it is important to consider the toll it takes on them. Ensuring that all of the costs of your care – emotional and financial – are not an additional burden, will provide you with peace of mind and let you focus on living your life as independently as possible.


Is long-term care insurance affordable? 

Long-term care insurance is more affordable than you might think, with a variety of plans, benefits levels and features available to suit your needs and budget. You’ve worked hard to build your savings and long-term care insurance is a way to help protect those savings. You can manage the costs of long-term care insurance by choosing a plan that matches the financial and retirement goals that are right for you and your family. Since the cost of long-term care insurance coverage is based on the age when you apply, in general, the younger you are, the lower your premiums. Visit our Financial Planning page to learn more about how you can plan your future.


What is the cost of waiting to buy long-term care insurance? 

The cost of waiting to buy may be significant – both in terms of how much you will pay as a result of buying it at an older age, and in terms of whether you might not qualify if you develop a health condition that makes you ineligible to obtain insurance. For your peace of mind, you should consider buying long-term care insurance for you and your family between the ages of 40-50. Generally, the younger and healthier you are when you buy long-term care insurance, the lower your premiums will be. Waiting too long could decrease your likelihood of being accepted and will increase the cost of your insurance.


What protections are in place for consumers? 

The National Association of Insurance Commissioners has established detailed industry-wide standards to protect consumers. Most states have adopted these standards and require insurance companies selling in those states to adhere to them. These include protections against arbitrary rate increases, disclosure requirements for all privacy provisions and flexibility for consumers to adjust their policy benefits to meet future needs and reduce costs should they choose to do so. Another important consumer safeguard – buy insurance from a company you can trust to be around in 20-30 years and check the financial rating and claims paying abilities of the companies you are considering.


[1]Kemper, P, Komisar, H and Alecxih, L. “Long-Term Care Over an Uncertain Future: What Can Current Retirees Expect?” Inquiry. 42: 335-350, Winter 2005/2006

[2] Kemper, P, Komisar, H and Alecxih, L. “Long-Term Care Over an Uncertain Future: What Can Current Retirees Expect?” Inquiry. 42: 335-350, Winter 2005/2006

[3] “Caregiving Across the States,” Family Caregiver Alliance, November 2007.


[4] LifePlans, Inc., “Descriptive Analysis of Patterns of Informal and Formal Caregiving among Privately Insured and Non-Privately Insured Disabled Elders Living in the Community,” April 1999