Long-term care insurance: what is it and how does it work? 

What is long-term care insurance?

Long-term care (LTC) insurance is coverage offered as an alternative to Medicare and Medicaid.

It’s available to people aged 65 and over with a chronic disability or ongoing health condition that requires round-the-clock care.

By 2050, predictions suggest that US spending on LTC insurance will add up to 3 per cent of the country’s total GDP – demand is high for these plans, and is rising. 

The US Department of Health and Human Services reports that about 70 per cent of adults over 65 have an LTC insurance policy.

Since services like nursing and home healthcare can be extremely costly (especially in the current financial climate), these policies help fund those services.  

The main benefit of LTC insurance is that it provides financial support for things that traditional health insurance policies do not cover.

This includes help with ADLs (Activities of Daily Living) such as bathing, dressing, and eating. 

What types of LTC insurance are available?

So, how does LTC insurance work?

LTC policies cover you in exchange for a premium that you pay monthly or annually.

There are two main kinds of LTC policy – traditional and hybrid.

Most policies, traditional and hybrid, cap the amount covered per day and throughout your lifetime at a certain point.

If you have a traditional policy, your insurer reimburses you the cost of the care you need in places like your home, your nursing home, or your assisted living facility.  

Most traditional plans have an “elimination period” you need to account for.

This means you must receive the care for a certain amount of time before being reimbursed by your insurer, typically between 30 to 90 days.

Also, traditional policies usually offer a predetermined amount of coverage for each service. For example, your LTC plan might provide $5,000 for home care.  

Hybrid plans combine an LTC plan with an existing whole life insurance plan (one of several types of permanent life insurance).

If your LTC plan is a hybrid, it is usually more flexible, allowing you to use the money from your life insurance to pay for ongoing care bills.

Plus, if you never need care, your beneficiaries are still able to inherit the funds. 

How do I buy LTC insurance?

You can buy LTC insurance directly from an insurer or an agent, and it is cheaper to buy it when you’re younger than 65.

To give you a better idea of the right time to buy, the average age of a person buying LTC insurance in the US is 57.  

The best practice is always to shop around and compare quotes from multiple companies for the same coverage period.

Independent agents are the most reliable option to help you with this process.

If you do decide to seek help, approach agents who participate in long-term care partnership policies. 

How much does LTC insurance cost?

The cost of healthcare in America is high, especially for elderly care.

Without coverage, a month of adult day care costs an average of $1,690, and a month spent in a private room at a nursing home costs an average of $9,034.  

How much is LTC insurance?

In the context of the figures above, it costs far less.

Like all types of insurance, the exact amount you pay differs depending on age, sex, chosen plan, and insurer. Traditional policies are usually cheaper than hybrid policies.  

Here’s an example: As of 2022, a 60-year-old single male is looking at an annual premium of $1,175 with level benefits.

This is $1,900 for a 60-year-old single female, as women statistically live longer than men, and insurers account for this. 

Do I need LTC insurance? How much do I need?

Two of the most commonly asked questions surrounding LTC insurance are “Should I get LTC insurance?” and “How much LTC insurance do I need?” Let’s tackle both.

Firstly, do you need LTC insurance? In most cases, yes. 

If you’re in a solid financial position and feel confident you’ll be able to cover care expenses at the end of your life, you may not need it.

If you’re a low-income individual or family, you may be covered by Medicaid or Medicare.

But if you’re in the middle, especially without substantial savings or children you can rely on for assistance in your twilight years, you’ll probably need some help. 

Secondly, how much do you need? Review how much you expect to spend on health care after retirement.

You can’t be exact, but you can estimate and make an informed guess based on your past and current health and your family’s medical history.

Once you’ve done this, figure out how much you can put toward your LTC budget.

Take away the cost of services, and the remainder is how much an insurance carrier can cover. 

Alternatives to LTC insurance

Yes, there are multiple alternatives to LTC insurance.

Being rejected by an LTC carrier can undoubtedly be a problem, but plenty of options could work better for your specific condition.

These include: 

• Short-term care insurance – A short-term care policy usually covers $100 to $200 of healthcare costs per day for less than a year. There’s no elimination period, so you can start receiving the benefits immediately. 

• Critical care or critical illness insurance – These policies offer cash in lump sums to people who have experienced a stroke or heart attack/been diagnosed with cancer or another immediately serious illness. 

• Annuity with LTC providers – This annuity needs to be paid for up front, but it’s offered tax-free, and the person can then use the monthly payment toward the cost of care. 

• Differed annuity– This annuity is purchased before retirement, and in return, an insurer pays a monthly sum when you reach a specific age. This money doesn’t have to be used exclusively for LTC.