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Long-Term Care Insurance


Many or all of the products featured here are from our partners who compensate us.
This may influence which products we write about and where and how the product
appears on a page. However, this does not influence our evaluations. Our opinions are
our own.

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Long-Term Care
Insurance Explained
BARBARA MARQUAND
• Insurance, Life Insurance
Jan. 13, 2022

It might be hard to imagine now, but chances are you’ll need some help
taking care of yourself later in life. The big question is: How will you pay
for it?

Buying long-term care insurance is one way to prepare. Long-term care

refers to a host of services that aren’t covered by regular health
insurance. This includes assistance with routine daily activities, like
bathing, dressing or getting in and out of bed.

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 AD

See how much you can save on

long term care insurance:

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Discounts of up to
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select insurance
providers
*Disclaimer: Discounts vary by carrier. To qualify for the maximum available discount, applicant
must qualify for marital and good health discounts.

A long-term care insurance policy helps cover the costs of that care
when you have a chronic medical condition, a disability or a disorder
such as Alzheimer’s disease. Most policies will reimburse you for care
given in a variety of places, such as:

Your home.

A nursing home.

An assisted living facility.

An adult day care center.

Considering long-term care costs is an important part of any long-range

financial plan, especially in your 50s and beyond. Waiting until you need
care to buy coverage isn’t an option. You won’t qualify for long-term
care insurance if you already have a debilitating condition, and long-term
care insurance carriers won’t approve most applicants over the age of
75. The majority of people with long-term care insurance buy it in their
TOP PICKS mid-50s to mid-60s.
GUIDES TOOLS MY NERDWALLET
 mid 50s to mid 60s.

Whether long-term care insurance is the right choice depends on your

situation and preferences.

Before you shop for coverage, it’s important to learn more about the
following topics:

Why buy long-term care insurance?

How popular is long-term care insurance?

How long-term care insurance works

Cost of long-term care insurance

Tax advantages of buying long-term care insurance

How to buy long-term care insurance

Understanding state “partnership” plans

Why buy long-term care insurance?

Nearly 70% of 65-year-old people will need long-term care services or
support, according to 2020 data from the Administration for Community
Living, part of the U.S. Department of Health and Human Services.
Women typically need care for an average of 3.7 years, while men
require it for 2.2 years.

Regular health insurance doesn’t cover long-term care. And Medicare

won’t come to the rescue, either; it covers short nursing home stays or
limited amounts of home health care when you require skilled nursing or
rehab only. It doesn’t pay for custodial care, which includes supervision
and help with day-to-day tasks.

If you don’t have insurance to cover long-term care, you’ll have to pay for
it yourself in most states. You can get help through Medicaid, the federal
and state health insurance program for those with low incomes, but only
after you’ve exhausted most of your savings.

Nerdy Tip:
Starting in 2025, Washington state will provide long-term
care insurance to eligible residents, funded by a payroll tax that
begins in 2022. Washington workers may opt out of the program if
they buy a private long-term care insurance policy before November
TOP PICKS
1, 2021. VisitGUIDES
the WA Cares Fund website for more information.
TOOLS MY NERDWALLET
 People buy long-term care insurance for two reasons:

1. To protect savings. Long-term care costs can deplete a retirement

nest egg quickly. The median cost of care in a semiprivate nursing
home room is $93,072 a year, according to Genworth’s 2020 Cost of
Care Survey.

ANNUAL MEDIAN COSTS OF LONG-TERM CARE IN 2020

Assisted
Home Homemaker Adult day Nursing
living
health aide services health care home care
facility

$54,912 $53,772 $19,236 $51,600 for $93,072 for

a private a
one- semiprivate
bedroom room

$105,852 for
a private
room

Source: Genworth 2020 Cost of Care Survey

2. To give you more choices for care. The more money you can spend,
the better the quality of care you can get. If you have to rely on
Medicaid, your choices will be limited to the nursing homes that
accept payments from the government program. Medicaid doesn’t pay
for assisted living in many states.

Buying long-term care insurance might not be affordable if you have a

low income and little savings. The National Association of Insurance
Commissioners says some experts recommend spending no more than
5% of your income on a long-term care policy.

How popular is long-term care insurance?

The number of insurance companies selling long-term care insurance has
plummeted since 2000. Slightly more than 100 insurers were selling
policies in 2004, according to 2020 data from the National Association
of Insurance Commissioners. About a dozen are selling policies today.
TOP PICKS GUIDES TOOLS MY NERDWALLET
 The uncertain cost of paying future claims as well as low interest rates
since the 2008 recession led to the mass exodus from the market. Low

interest rates hurt because insurers invest the premiums their customers
pay and rely on the returns to make money.

The market is continuing to change. Genworth, one of the largest

remaining carriers, suspended sales of individual long-term care
insurance through agents and brokers in March 2019. The company sells
policies to groups and directly to individual consumers through its own
sales department.

How long-term care insurance works

To buy a long-term care insurance policy, you fill out an application and
answer health questions. The insurer may ask to see medical records and
interview you by phone or face to face.

You choose the amount of coverage you want. The policies usually cap
the amount paid out per day and the amount paid during your lifetime.

Once you’re approved for coverage and the policy is issued, you begin
paying premiums.

Under most long-term care policies, you’re eligible for benefits when you
can’t do at least two out of six “activities of daily living,” called ADLs, on
your own or you suffer from dementia or other cognitive impairment.

The activities of daily living are:

Bathing.

Caring for incontinence.

Dressing.

Eating.

Toileting (getting on or off the toilet).

Transferring (getting in or out of a bed or a chair).

When you need care and want to make a claim, the insurance company
will review medical documents from your doctor and may send a nurse
TOP PICKS to do an evaluation.
GUIDES Before approving a claim, the insurer must approve
TOOLS MY NERDWALLET
 to do a eva uat o e o e app ov g a c a ,t e su e ust app ove
your plan of care.

Under most policies, you’ll have to pay for long-term care services out of
pocket for a certain amount of time, such as 30, 60 or 90 days, before
the insurer starts reimbursing you for any care. This is called the
“elimination period.”

The policy starts paying out after you’re eligible for benefits and usually
after you receive paid care for that period. Most policies pay up to a
daily limit for care until you reach the lifetime maximum.

Some companies offer a shared care option for couples when both
spouses buy policies. This lets you share the total amount of coverage,
so you can draw from your spouse’s pool of benefits if you reach the
limit on your policy.

Cost of long-term care insurance

The rates you pay depend on a variety of things, including:

Your age and health: The older you are and the more health problems
you have, the more you’ll pay when you buy a policy.

Gender: Women generally pay more than men because they live
longer and have a greater chance of making long-term care insurance
claims.

Marital status: Premiums are lower for married people than for single
people.

Insurance company: Prices for the same amount of coverage will vary
among insurance companies. That’s why it’s important to compare
quotes from different carriers.

Amount of coverage: You’ll pay more for richer coverage, such as

higher limits on the daily and lifetime benefits, cost-of-living
adjustments to protect against inflation, shorter elimination periods,
and fewer restrictions on the types of care covered.

A single 55-year-old man in good health buying new coverage can

expect to pay an average of $1,700 a year for a long-term care policy
with an initial pool of benefits of $164,000, according to the 2020 price
TOP PICKS
index from theGUIDES
American Association for Long-Term Care Insurance
TOOLS MY NERDWALLET
 index from the American Association for Long Term Care Insurance.
Those benefits compound annually at 3% to total $386,500 at age
85. For the same policy, a single 55-year-old woman can expect to pay
an average of $2,675 a year. The average combined premiums for a 55-
year-old couple, each buying that amount of coverage, are $3,050 a
year.

A caveat: The price could go up after you buy a policy; prices aren’t
guaranteed to stay the same over your lifetime. Many policyholders saw
spikes in their rates in the past several years after insurance companies
asked state regulators for permission to hike premiums. They were able
to justify rate increases because the cost of claims overall were higher
than they had projected. Regulators approved the rate increases
because they wanted to make sure the insurance companies would have
enough money to continue paying claims.

Tax advantages of buying long-term care

insurance
Long-term care insurance can have some tax advantages if you itemize
deductions, especially as you get older. Federal and some state tax
codes let you count part or all of long-term care insurance premiums as
medical expenses, which are tax deductible if they meet a certain
threshold. The limits for the amount of premiums you can deduct
increase with your age.

2021 federal tax deductible limits for long-term care insurance

Age at the end of the year Maximum deductible premium

40 or under $450

41 to 50 $850

51 to 60 $1,690

61 to 70 $4,520

71 and over $5,640

Source: IRS Revenue Procedure 2020-45.

Only premiums for tax-qualified long-term care insurance policies count

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di l S h li i t t t i f d l t d d
 as medical expenses. Such policies must meet certain federal standards
and be labeled as tax-qualified. Ask your insurance company whether a
policy is tax-qualified if you’re not sure.

How to buy long-term care insurance

You can buy directly from an insurance company or through an agent.

You might also be able to buy a long-term care policy at work. Some
employers offer the opportunity to purchase coverage from their brokers
at group rates. Usually when you buy coverage this way, you’ll have to
answer some health questions, but it could be easier to qualify than if
you buy it on your own.

Get quotes from several companies for the same coverage to compare
prices. That holds true even if you’re offered a deal at work; despite the
group discount, you might find better rates elsewhere.

The American Association for Long-Term Care Insurance advises

working with an experienced long-term care insurance agent who can
sell products from at least three carriers.

In its 2019 price comparison, the association found that rates varied
widely among insurers.

Understanding state ‘partnership’ plans

Most states have “partnership” programs with long-term care insurance
companies to encourage people to plan for long-term care.

Here’s how it works: The insurers agree to offer policies that meet certain
quality standards, such as providing cost-of-living adjustments for
benefits to protect against inflation. In return for buying a “partnership
policy,” you can protect more of your assets if you use up all the long-
term care benefits and then want help through Medicaid. Normally in
most states, for instance, a single person would have to spend down
assets to $2,000 to be eligible for Medicaid. If you have a partnership
long-term care plan, you can qualify for Medicaid sooner. In most states,
you can keep a dollar that you would normally have had to spend to
qualify for Medicaid for every dollar your long-term care insurance paid
out.

To find out whether your state has a long-term care partnership

TOP PICKS
program check with your state’s insurance departmentTOOLS
GUIDES MY NERDWALLET
 program, check with your state s insurance department.

As you make a long-range financial plan, the potential cost of long-term

care is one of the important things you’ll want to consider. Talk to a
financial advisor about whether buying long-term care insurance is the
best option for you.

NEXT ▻
Alternatives to Buying Long-
Term Care Insurance

About the author

Barbara Marquand
Barbara Marquand writes about mortgages, homebuying and
homeownership.
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 The 20 Largest Life Insurance The Best Life Insurance Companies
Companies

Find The Best Term Life Insurance The Differences Between Term and
Whole Life Insurance

Many or all of the products featured here are from our partners who compensate us.
This may influence which products we write about and where and how the product
appears on a page. However, this does not influence our evaluations. Our opinions are
our own.

Advertiser Disclosure

Alternatives to
Buying Long-Term
Care Insurance
BARBARA MARQUAND
• Insurance, Life Insurance
Jan. 13, 2022

Buying long-term care insurance is one way to plan financially for a time
TOP PICKS GUIDES TOOLS MY NERDWALLET
when you might need to pay for help to take care of yourself But it’s not
 when you might need to pay for help to take care of yourself. But it s not
the only way to pay for in-home care, adult day care, assisted living or a
nursing home.
There are also age restrictions for purchasing a policy. If you’re over the
age of 75, most long-term care insurance carriers won’t approve you for
a policy.

Before you buy a policy, it’s a good idea to explore alternatives.

A quick refresher
Long-term care refers to a host of services to help with “activities of
daily living,” such as bathing, eating and remembering to take
medication. Regular health insurance and Medicare pay for medical
expenses. But they don’t pay for custodial care, which is the nonmedical
help with routine activities. Medicaid, the federal and state health
insurance program for low-income people, pays for nursing home care.
But you have to spend most of your money first before you qualify.

AD

See how much you can save on

long term care insurance:

City State
Select a State

Get Started
on LTC Consumer

Discounts of up to
30% available with
select insurance
providers
*Disclaimer: Discounts vary by carrier. To qualify for the maximum available discount, applicant
must qualify for marital and good health discounts.

Planning is vital once you reach your 50s and 60s, because long-term
care is expensive. Among 65-year-olds, nearly 70% will require long-term
TOP PICKS
care services GUIDES
according to 2020 data from the Administration
TOOLS
for MY NERDWALLET
 care services, according to 2020 data from the Administration for
Community Living, part of the U.S. Department of Health and Human
Services. Of those who require long-term care, men will need services for

an average of 2.2 years, and women will need them for an average of 3.7
years.

A long-term care insurance policy pays for care up to the policy’s limits if
you have a severe cognitive impairment, such as dementia, or you can’t
do two out of six activities of daily living. Those are:

Bathing.

Caring for incontinence.

Dressing.

Eating.

Toileting (getting on or off the toilet).

Transferring (getting in or out of a bed or a chair).

Most policies sold today pay for care in a nursing home, assisted living
facility, adult day care center or at home.

But some buyers are wary about shelling out a lot of money for coverage
they may never use. And there is no guarantee that your annual policy
price won’t increase in the future. In the past decade, many long-term
care insurance policyholders have been hit with big price hikes.

Here are alternatives to buying a long-term care insurance policy.

Save money for long-term care

If you have robust savings, you could plan to pay for long-term care out
of pocket.

Pro: You don’t risk paying for insurance that you may never use.

Con: A few years of care could put a big dent in your savings, leaving
less money for your heirs. You could also run out of money. In that
case, you could apply for coverage through Medicaid, which would
pay for nursing home care. But then your options would be limited to
facilities that accept Medicaid patients. And the program doesn’t pay
TOP PICKS for assistedGUIDES
living in every state. TOOLS MY NERDWALLET
 Tap into ‘living benefits’ on a life insurance
policy
Also known as an “accelerated death benefit,” this feature is available on
most permanent life insurance policies such as whole life insurance. It
lets you take a portion of the life insurance payout while you’re still alive
to pay for medical expenses, including long-term care. The death benefit
is reduced by the amount used for long-term care.

Pro: The cost is included in your rates on some life insurance policies,
and you can add it for a small cost on others when you buy.

Con: The triggers for when you can access the benefits for care vary
by company, so read the fine print carefully. A trigger could be a
terminal illness diagnosis. Also, using the policy for long-term care
reduces the payout your life insurance beneficiaries will get.

Sell your life insurance policy

You can sell your permanent life insurance policy and use the proceeds
for anything you want, including long-term care expenses.

Pro: The proceeds you get from selling your policy, a transaction
called a life settlement or viatical settlement, are usually more than
what you’d get if you surrendered the policy for the cash value.

Con: The proceeds may be taxed, and your survivors will no longer get
a death benefit from the policy. (When you die, the death benefit will
go to the new owner of your policy.) It can be tough to tell if you’re
getting a fair price. Life settlements generally aren’t available for term
life insurance policies.

» MORE: Before death do us part: Selling your life insurance policy

Use an annuity
You can buy an immediate annuity to provide a steady stream of income
to pay for long-term care. With an immediate annuity, you pay a one-
TOP PICKS GUIDES TOOLS MY NERDWALLET
ti l d th i id t d t fi
 time lump sum and the insurer provides a guaranteed stream of income
for a certain period or the rest of your life. The amount you receive
depends on how much you paid in and your age, health and gender.
Pro: You can buy an immediate annuity even if you’re in poor health. In
fact, you can qualify for a higher annual payout from the annuity if
you’re in poor health than if you’re in good health.

Con: You need a large sum of cash to invest, such as $50,000 or more.
The income from the annuity still might not be enough to pay for your
care. The tax implications for annuities are complex, so you’ll want to
talk with a tax advisor to understand the future tax bills.

Buy a combination long-term care/life

insurance policy
These policies, also called asset-based or hybrid life insurance and long-
term care insurance policies, provide a pot of money for long-term care
if you need it or a death benefit to your beneficiary if you don’t max out
the long-term care benefits. Typically you pay one large premium
upfront, such as $75,000, or a few large payments over a few years.
Under some policies, such as the Lincoln MoneyGuard II from Lincoln
Financial, you can get your money back if you decide years later you
don’t want the policy.

Pro: You get something for your money even if you never use the
long-term care portion of the policy. If you don’t use it for long-term
care, or don’t use all of it, your beneficiary gets a life insurance payout
when you die.

Con: It’s an option only if you have a large sum of money to spend.

Buy a short-term care insurance policy

Short-term care insurance covers the same types of care as long-term
care policies, but for a shorter period of time — three months to 360
days. You choose the period when you buy. Generally, short-term care
insurance has no “elimination period,” or waiting period, so the policy
starts paying out as soon as you start using care. The elimination period
on a long-term care policy works like a deductible: It’s the number of
days you pay for care before the policy pays out. A typical elimination
TOP PICKS period is 90 days.
GUIDES TOOLS MY NERDWALLET
 pe od s 90 days

Short-term vs. long-term care insurance

Short-term care Long-term care

 
insurance insurance

Lower in price ✓

No deductible ✓

Easy to qualify for ✓

coverage

Can provide coverage ✓

for more than one year

Must meet tougher ✓

consumer protection
standards set by states

Pro: A short-term care insurance policy costs less than a long-term

care policy and is easier to qualify for. Although the coverage lasts less
than a year, that might be all you need. You can also buy a short-term
care insurance policy to pay for care during the elimination period of a
long-term care insurance policy.

Con: A short-term care insurance policy won’t provide enough

coverage if you need care for more than a year. It might make more
sense to save money for several months of care than to pay year after
year for a short-term care policy. In addition, states don’t regulate
short-term care policies as tightly as they regulate long-term care
policies, so they’re not held to the same consumer protection
standards. That means you need to be extra careful when buying. For
example, long-term care policies must be “guaranteed renewable,”
which means the policy renews year after year as long as you continue
to pay for it. Many short-term care policies are guaranteed renewable,
but they’re not required to offer that protection. In a review of policies
on the market, consumer advocates found at least one that did not
guarantee renewal. Under that policy, the insurer could refuse to renew
coverage, even after you’d paid years for it and had never made a
claim.

TOP PICKS Get help charting the right course

GUIDES TOOLS MY NERDWALLET
 p g g

Financially planning for long-term care is tricky. Before you buy any
insurance, talk to a trusted financial advisor to help you plan for long-
term care expenses. A fee-only advisor doesn’t earn commissions on
product sales and can help you look objectively at the big picture.

◅ PREVIOUS NEXT ▻
Long-Term Care Insurance Ordering the Combo: Life
Explained Insurance with Long-Term Care
Benefits

About the author

Barbara Marquand
Barbara Marquand writes about mortgages, homebuying and
homeownership.
Read more

twitter Twitter email Email

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WITH THE NERDWALLET LIFE INSURANCE

TOOL, YOU CAN:

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 The 20 Largest Life Insurance The Best Life Insurance Companies
Companies

Find The Best Term Life Insurance The Differences Between Term and
Whole Life Insurance

Many or all of the products featured here are from our partners who compensate us.
This may influence which products we write about and where and how the product
appears on a page. However, this does not influence our evaluations. Our opinions are
our own.

Advertiser Disclosure

Ordering the
Combo: Life
Insurance with Long-
Term Care Benefits
BARBARA MARQUAND
• Insurance, Life Insurance
TOP PICKS GUIDES TOOLS MY NERDWALLET
J l 16 2021
 July 16, 2021

The biggest risk of buying long-term care insurance is that you might
spend tens of thousands of dollars on something you won’t use. Policies
pay for nursing homes, assisted living or home health care — but what if
you never need these services? New types of policies combine long-term
care insurance with permanent life insurance, such as whole or universal
life.

If you want both types of coverage and can front the money, these
hybrid options are worth a look.

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How combination policies work

Combination long-term care/life insurance policies pay for long-term
care that regular health insurance or Medicare won’t cover. And if you
don’t max out the long-term care benefits, the insurer pays a benefit to
your beneficiary upon your death.

Also called linked or asset-based policies, combination products work

this way:

Depending on the policy, you pay one lump-sum premium or a few

TOP PICKS
large annualGUIDES
premiums — typically for fewer than 10 years,
TOOLS
according MY NERDWALLET
 to LIMRA, an industry research and consulting group. The average cost

of a single-premium combination policy is $75,000, according to the

American Association for Long-Term Care Insurance.

The policy provides a pot of money for long-term care that’s equal to
several times your premium payments.

The policy’s death benefit will be reduced — which means less money
for your life insurance beneficiary — according to how much of the
long-term care benefit you use. Some policies guarantee a small
percentage of the full death benefit, such as 10%, even if you use all
the money allocated for long-term care.

You’ll need to supply medical records and take a life insurance medical
exam to qualify for some combination policies. Others offer “simplified
underwriting,” which means you may only need to answer health
questions over the phone. If you’re healthy, you’ll pay less for coverage
if you buy a policy that requires both an exam and submission of
medical records.

Combination policies differ, but here’s a hypothetical example for a

MoneyGuard II policy from Lincoln Financial: A 60-year-old female
nonsmoker pays a single $100,000 premium for up to $453,783 in long-
term care benefits, or about 4.5 times the premium. Long-term care
benefits could pay out for up to six years, at up to $6,303 per month. If
she never used the policy for long-term care, it would pay a death
benefit of $151,261 to her beneficiary. And after year five, she could get
her $100,000 back if she didn’t want the policy any longer and hadn’t
used any of the long-term care benefits.

Interest in combination long-term care/life insurance policies has taken

off. In 2021, more than one-fourth of Americans said they were very likely
to consider a combination policy if they were shopping for life insurance,
up from 17% in 2019, according to LIMRA.

The appeal of combination policies

Aside from the fact that you get something for your premium no matter
what, the biggest advantages of combination policies are:

TOP PICKS The policy can be a good investment if you otherwiseTOOLS

GUIDES would have MY NERDWALLET
 spent the money or kept it in a low-yield account.

You won’t have premium hikes when you pay with a lump sum, and a
policy with a limited number of payments might even guarantee the
premiums will stay the same. Some owners of traditional long-term
care insurance policies have seen their premiums double within the
past several years as care costs have surpassed insurance companies’
projections. And with historically low interest rates, insurers haven’t
made enough investment income off of premiums to pay claims.

There’s a money-back guarantee with some combination policies. The

insurance company will return your premium if you decide you don’t
want the policy after a certain period of time, such as five years.
Before then, you can get a percentage of the premium back.

The downsides
A combination long-term care/life insurance policy is probably not for
you if:

You only need life insurance. In that case, you should buy a regular
term or permanent life insurance policy. Term life, designed to cover
the years that your family depends on your income, is sufficient for
most people. Permanent life insurance covers you for your whole life.

You don’t want permanent life insurance. If you need only temporary
coverage, shop for term life insurance, which is much cheaper.

You don’t have $75,000 (or more) burning a hole in your pocket. The
American Association for Long-Term Care Insurance says that
combination policies are best for people who have “lazy money”
sitting in CDs or money market accounts.

Get advice before you decide

If you do decide on a combination policy, compare quotes from multiple
insurers, and check the insurance companies’ financial strength ratings
before you buy. It takes only a few minutes to look them up on the
websites of independent rating firms, such as A.M. Best, Fitch Ratings,
Moody’s Investors Service or Standard & Poor’s Ratings Services. (You
TOP PICKS GUIDES TOOLS MY NERDWALLET
might have to register on some sites to access ratings but registration is
 might have to register on some sites to access ratings, but registration is
free.) The ratings agencies issue grades for insurance companies, and
each agency has its own scale.
Combination policies are complex products, and their costs and benefits
vary. Before you buy, talk with a financial advisor who understands these
products and can compare them to stand-alone long-term care and life
insurance options.

◅ PREVIOUS NEXT ▻
Alternatives to Buying Long- 5 Insider Tips for Finding
Term Care Insurance Affordable Long-Term Care
Insurance

About the author

Barbara Marquand
Barbara Marquand writes about mortgages, homebuying and
homeownership.
Read more

twitter Twitter email Email

Compare life insurance rates easily

WITH THE NERDWALLET LIFE INSURANCE

TOOL, YOU CAN:

Get instant quotes for term life insurance.

See a price comparison for multiple
carriers.

Get quotes

You may also like

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 The 20 Largest Life Insurance The Best Life Insurance Companies
Companies

Find The Best Term Life Insurance The Differences Between Term and
Whole Life Insurance

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