Long-term Care Insurance Basics: What It Covers. How Much It Costs.

Shawn Plummer

CEO, The Annuity Expert

What Is Long-Term Care Insurance?

Long-term care insurance helps individuals pay for extended care services, such as assistance with daily activities or nursing home care, in the event of a chronic illness, disability, or old age. It provides financial protection for the high costs of long-term care when traditional health insurance or Medicare does not cover it.

Key Takeaways:

  1. Understanding Long-Term Care Insurance: Long-term care insurance (LTCI) is designed to cover extended care services for individuals needing assistance due to aging, chronic conditions, or disability. It covers various care settings, including home health care, assisted living facilities, and nursing homes.
  2. Who Should Get LTCI: Ideal candidates are between ages 45 and 85. LTCI protects assets and savings from being used for care.
  3. Pros and Cons: LTCI offers financial protection, access to quality care, and flexibility in care options. However, it can have high premiums, and there’s a possibility of never using the benefits.
  4. Insurance Premiums: The average annual premium for a traditional long-term care insurance policy for a couple aged 55 is $5,025.
  5. Coverage Limits: Traditional long-term care insurance policies offer a maximum average daily reimbursement of $150 (equivalent to $4,500 per month) for 3-5 years.

How Does Long-Term Care Insurance Work?

Long-term care insurance provides coverage for individuals who need assistance with daily activities due to a chronic illness or disability. It typically pays for in-home care, nursing home care, and assisted living facilities. To benefit from this insurance, policyholders pay regular premiums and must meet specific eligibility criteria, such as being unable to perform a certain number of activities of daily living independently. The specific coverage and benefits vary depending on the policy and individual circumstances.

How Much Does Long-Term Care Insurance Cost?

Long-term care insurance costs vary based on age, health, and coverage amount. A 55-year-old can expect to pay around $2,500 annually for a comprehensive policy. However, prices can range from a few hundred dollars to over $10,000 annually, so comparing quotes from different providers is essential to find the best option.

Factors Influencing Cost

  • Age: The younger you are when you purchase an LTCI policy, the lower your premiums will generally be. This is because younger individuals are seen as lower risk by insurers.
  • Health Condition: Your current health status and medical records significantly determine your premium costs. Individuals with pre-existing conditions or a history of chronic health issues may face higher premiums or even be denied coverage.
  • Location: Major cities are more expensive compared to smaller towns.
  • Benefit Amount and Duration: The amount of coverage you choose and the length of time you want the policy to provide benefits will also impact your premiums.
  • Inflation Rider: Inflation protection is an optional feature that helps your benefits keep pace with the rising care costs.

Long-Term Care Insurance Cost By Age

  • Costs for Individuals in Their 40s: Premiums are generally more affordable for individuals in their 40s, as insurers see them as lower risk.
  • Costs for Individuals in Their 50s: Premiums tend to increase as you enter your 50s; purchasing coverage at this age can still be more cost-effective than waiting until later.
  • Costs for Individuals in Their 60s: Premiums typically rise significantly for individuals in their 60s as the risk of needing long-term care services increases.
  • Costs for Individuals in Their 70s and Beyond: Premiums can be prohibitively expensive for those in their 70s and older. Some insurers may not even offer coverage to individuals in this age group.
AgeAverage Annual Premium
50$2,500 – $3,500
55$2,800 – $4,000
60$3,200 – $4,500
65$4,000 – $5,500
70$5,000 – $8,000
75$7,000 – $10,000+

What Does Long-Term Care Insurance Cover?

Long-term care insurance covers a range of services, such as nursing home care, in-home assistance, and adult day care, not typically covered by health insurance or Medicare. It helps individuals afford the costs associated with extended care due to chronic illness, disability, or old age.

Types of Care Covered

  • Home Health Care: Policies typically cover home health care services, such as assistance with activities of daily living (ADLs), skilled nursing care, and physical or occupational therapy.
  • Assisted Living Facility: An assisted living facility that provides housing, personal care services, and health care is generally covered by long-term care insurance policies.
  • Nursing Homes: Nursing home care, which provides round-the-clock skilled nursing care and assistance with ADLs, is typically covered by LTCI.
  • Adult Day Care Centers: Many policies cover adult day care centers, which provide seniors with daytime supervision and social activities.

What Does Long-Term Care Insurance Pay For?

The insurance pays for both formal and informal care that includes the following:

What Disqualifies From Long-Term Care Insurance?

Long-term care insurance may disqualify individuals based on certain factors. Common disqualifiers include pre-existing conditions, cognitive impairments, and disabilities that prevent performing basic daily activities. Age and specific health conditions may also make someone ineligible for coverage. It is essential to carefully review the terms and conditions of a policy to understand what disqualifies a person from long-term care insurance.

Common Exclusions and Limitations

  • Pre-existing Conditions: Some life insurance policies may exclude coverage for pre-existing conditions or require a waiting period before coverage begins.
  • Mental Health Conditions: Certain mental health conditions, such as Alzheimer’s disease or other forms of dementia, may not be covered or may have specific limitations on coverage.
  • Maximum Benefit Periods: Most long-term care insurance policies have maximum benefit periods, which cap the time you can receive benefits. It’s important to consider whether the benefit period you choose will be sufficient to cover your potential care needs.
  • Elimination Periods: Long-term care insurance policies often include an elimination period, a waiting period before benefits begin. During this time, you’ll be responsible for covering care costs. Choosing a more extended elimination period can lower your premiums but may also increase your out-of-pocket expenses when you need care.

Who Should Get Long-Term Care Insurance?

Those between 45 and 85 are ideal candidates for LTC insurance, as it allows them to secure coverage without depleting their assets. LTCI is designed to help protect one’s assets and savings from being used to pay for care. Some other examples of people who need LTCI.

  1. Individuals with a Family History of Chronic Illnesses: If there’s a history of chronic diseases like Alzheimer’s, Parkinson’s, or other debilitating conditions in your family, you might be at a higher risk of needing long-term care.
  2. Those Without Family Caregivers: Long-term care insurance can be beneficial if you don’t have close family members who can care for you in your old age or are not equipped to provide the care you might need.
  3. People with Assets to Protect: If you have significant assets that you want to preserve as an inheritance for your heirs, long-term care insurance can help protect those assets from being depleted by the high costs of long-term care.
  4. Individuals Who Value Independence: Insurance can ensure you get professional care without burden if you value your independence and don’t want to rely on family or friends for care.

The Three Types Of Long-Term Care Policies

In the world of long-term care insurance, there are three general types of policies.

  • Reimbursement Policies: These are the most common. They reimburse you for eligible care expenses up to a daily or monthly limit. For example, if your policy has a daily limit of $150 and you only spend $100 on care services, you’ll get reimbursed for $100, not $150.
  • Indemnity Policies: Under this type, the insurer pays a fixed daily benefit, regardless of expense. So, if your policy has a daily benefit of $150, you’ll receive $150 even if you only spend $100 on care services.
  • Partnership Policies: These policies protect your assets if you apply for Medicaid after using your policy benefits. If your policy paid $200,000 in benefits, you can keep an extra $200,000 in assets and qualify for Medicaid.

The Pros And Cons Of Long-Term Care Insurance

Pros

  • Financial Protection: LTCI can help safeguard your assets and income by covering the often substantial costs associated with extended care services, thus reducing the burden on you and your family.
  • Access to Quality Care: With LTCI, you can access a broader range of care providers and services, allowing you to choose the best care for your unique needs and preferences.
  • Flexibility in Care Options: LTCI policies typically cover various types of care, including in-home care, assisted living, and nursing home care, providing you with the flexibility to choose the most appropriate care setting as your needs evolve.
  • Peace of Mind: Knowing that you plan to cover potential long-term care expenses can provide peace of mind for you and your loved ones, alleviating concerns about the financial burden of care.

Cons

  • High Premiums: LTCI premiums can be expensive, particularly for those who purchase policies later in life, and may be unaffordable for some individuals.
  • Possibility of Never Using the Benefits: Some policyholders may never require long-term care services, meaning the premiums paid for coverage essentially go unused.
  • Limited Benefit Periods: Many LTCI policies have limited benefit periods, which means that coverage may expire before you’ve exhausted your need for care, potentially leaving you to cover remaining expenses out of pocket.
  • Exclusions and Limitations: LTCI policies often have exclusions and limitations, such as pre-existing conditions, waiting periods, and restrictions on certain types of care, which may result in denied or reduced coverage for some services.

Best Long-Term Care Insurance Companies

Multiple insurance companies offer good policy benefits and reasonable monthly premiums:

  • Global Atlantic: Offers a fixed annuity providing long-term care benefits, flexible coverage, and guaranteed returns.
  • OneAmerica: Provides asset-based long-term care solutions with Asset Care, Lifetime Benefit riders, and joint coverage options for couples, combining life insurance with long-term care benefits.
  • GILICO: Known for flexible coverage options, competitive pricing, and strong financial ratings, making them a trusted provider of long-term care insurance.
  • Mutual of Omaha: A long-standing leader in long-term care insurance, offering comprehensive coverage, various discounts and incentives, and exceptional customer service.
  • Nationwide: Provides a range of long-term care insurance products, features a Care Concierge program, and firmly commits to financial stability and customer satisfaction.
What Is Long Term Care Insurance? How Does Long Term Care Insurance Work? What Disqualifies From Long-Term Care Insurance?

Tips For Finding The Best Deal

Now that you know the different places to purchase long-term care insurance, you may wonder how to find the best deal. Here are a few tips to help you get started:

  • Shop around and compare prices. This is one of the best ways to find a good deal on any insurance policy. Be sure to compare prices from a variety of different companies.
  • Check with your employer. Many employers offer long-term care insurance to benefit their employees, so check with your human resources department to see if this coverage is available.
  • Research government programs. As a senior citizen, you may be eligible for long-term care insurance through the government. The federal government offers the Long-Term Care Insurance Program (LTCIP) program to anyone over 55 who meets specific health requirements.
  • Check with your veterans’ benefits office. If you are a veteran, you may be eligible for long-term care insurance through the Department of Veterans Affairs (VA). The VA offers the Veterans Long-Term Care Insurance Program (VLTCTP).

Alternatives to Long-Term Care Insurance Policies

  • Self-Funding: Some individuals self-fund their long-term care expenses by setting aside savings or investments. This approach may suit those with significant financial resources or who are comfortable considering potentially high out-of-pocket costs.
  • Life Insurance with Long-Term Care Riders: Another option is to purchase a life insurance policy with a long-term care rider. This allows you to access a portion of your life insurance death benefit to pay for long-term care expenses while still providing a death benefit to your beneficiaries if you don’t use the entire amount for care.
  • Annuities with Long-Term Care Benefits: Some annuities offer long-term care benefits, allowing you to use a portion of your income to cover care expenses. This option may appeal to those already considering an annuity for retirement planning.
  • Health Savings Accounts (HSAs): If you have a high-deductible health plan (HDHP), you may be eligible to contribute to a Health Savings Account (HSA). HSA funds can be tax-free for qualified medical bills, including long-term care expenses.
  • Medicaid and Other Federal Government Programs: For those who meet the eligibility requirements, Medicaid provides coverage for long-term care, including nursing home care and some home and community-based services.

We’re A Long-Term Care Insurance Agency

The Annuity Expert is an independent agency specializing in long-term care insurance, offering services to shop, compare, and purchase long-term care insurance policies at the most affordable prices.

Next Steps

Long-term care insurance can provide valuable financial protection and peace of mind. Still, it’s essential to carefully weigh the pros and cons, understand the costs, and determine whether it’s the right choice for your unique situation. 

By considering your personal risk factors, financial resources, and long-term care preferences, you can decide whether to invest in LTCI or explore alternative options. Remember, planning is critical to ensuring that you and your loved ones receive the care and support you need in the future.

How Much Does Long Term Care Insurance Cost?

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Frequently Asked Questions

What is the best elimination period for long-term care Insurance?

According to industry experts, the best elimination period for LTCI is typically between 90 to 180 days. This time allows the policyholder to receive the maximum benefits from their policy while still having the lowest possible premiums.

What are some factors you should consider when buying long-term care insurance?

LTCI can be essential in planning for long-term financial security. However, before committing to a long-term care policy, you should consider several factors, such as the range of benefits offered, the length and type of coverage, and the monthly or annual premiums.

At what age should you consider purchasing long-term care insurance?

It is essential to consider purchasing long-term care insurance before the need arises, as eligibility is based on health factors, and costs increase with age. A good age to consider long-term care insurance is between 45 and 65 when individuals are still in relatively good health but may be planning for their long-term future. According to the American Association for Long-term Care Insurance, the best age to apply is mid-50s.

What happens if you run out of money for long-term care insurance?

A few options are available if you run out of money for LTCI. First, you may be eligible for government programs such as Medicaid, which can help offset long-term care costs. Additionally, you can look into other forms of financing, such as reverse mortgages, life settlements, long-term care insurance policy loans, or other forms of private funding.

What does Long-Term care insurance not cover?

Long-term care coverage does not apply to care provided by family members, medical care costs, daily benefit amounts, regular health insurance costs, home care-only services, activities of daily living, homemaker services, and policies based on health history. In addition, LTCI does not cover end-of-life expenses, including hospice or burial costs.

Do long-term care insurance premiums increase as you age?

Yes, premiums generally increase as you age. When purchasing a policy, younger individuals typically pay lower long-term care insurance rates since insurers consider them lower risk. As you age, the risk of requiring long-term care services increases, leading to higher premiums. Other factors that impact monthly premiums are age, gender, marital status, and health.

Is long-term care insurance worth it?

The Federal Government predicts that 7 out of 10 retirees above 65 will need some long-term care in their lifetime. Unfortunately, long-term care is not covered by regular health insurance. Medicare will not help either. Covered care only includes short stays in nursing homes or rehab, not custodial care.

How much does long-term care insurance cost?

Long-term care insurance costs vary significantly based on age, health status, benefit amount, duration, and optional features like inflation protection. Premiums are generally more affordable for younger, healthier individuals and increase with age. Exact costs differ between individuals and insurance providers, so obtaining quotes from multiple insurers is crucial to determining the best coverage and pricing for your unique situation.

How much coverage do you need?

Insurance companies offer different coverage that may pay the cost of a private room in a nursing home, along with additional expenses. You can use our free calculator to estimate how much coverage you need to cover the long-term care costs.

What is long-term disability insurance?

Disability insurance pays for the income you couldn’t earn due to a health condition that prevents you from working.

What are hybrid policies?

A hybrid policy is when an insurance carrier offers a product that includes whole-life and long-term care insurance. This policy costs more but ensures a death benefit for your family once you pass away. As a standard, the hybrid policy has fixed premiums that are not tax-deductible.

What are examples of long-term care?

The three main long-term care types are home-based, facility-based, and community-based services. Home-based care includes home health care, homemaker services, friendly visitor/companion services, and emergency response systems. Facility-based care includes nursing homes, assisted living facilities, and residential homes for older people. Community-based services include meals, adult day care, and transportation services.

What is the primary goal of LTC?

The main goal of long-term care services is to help people live as independently and safely as possible when they cannot perform everyday activities independently. These services focus on providing personal care and support to help people achieve their highest potential functioning and quality of life.

Why is Long-Term Care Important?

Long-term care is vital because it offers individuals access to specialized medical and personal care services and provides support and assistance with activities of daily living. It also helps to ensure a person’s safety and well-being while improving their overall quality of life.

Does long-term care insurance cover hospice?

Yes, long-term care insurance typically covers hospice care. Hospice care provides comfort and support for terminally ill patients. Coverage specifics vary by policy, so reviewing individual policy details is essential to determine the extent of hospice care coverage.

Does long-term care insurance cover in-home care?

Yes, long-term care insurance often covers in-home care. This allows policyholders to receive care in the comfort of their homes. However, coverage details can vary, so checking individual policy terms is crucial to understanding the in-home care benefits provided.

Can A Long-Term Care Insurance Policy Cover Both My Spouse And Me?

Yes, many long-term care insurance providers offer “shared care” policies. These allow couples to share a combined pool of benefits, covering both spouses under one policy. This can provide flexibility in how the benefits are used between the two individuals.

Does Long-Term Care Insurance Cover Independent Living?

Typically, long-term care insurance does not cover the costs of independent living or retirement communities. However, it can cover services received within those settings if they qualify as long-term care, like home health care. Policies vary, so it’s essential to review your policy’s specifics.

Does Long-Term Care Insurance Cover Assisted Living?

Yes, most long-term care insurance policies cover assisted living facilities, as they fall under the category of long-term care services. The amount and duration of coverage depend on the policy’s specifics. Always review your policy details to understand the extent of coverage.

How Do You Change Your Long-Term Care Insurance Coverage?

To change your long-term care insurance coverage, contact your insurance provider to discuss modifications. Review your policy terms and potential penalties. Once you’ve gathered information and decided on changes, submit any required documentation. Ensure you fully understand any changes to premiums or benefits before finalizing adjustments. Always maintain records of correspondence and changes.

What Does Long-Term Care Insurance Not Cover?

Long-term care insurance typically doesn’t cover medical care or treatments. Exclusions often include pre-existing conditions, mental disorders without organic cause, alcohol or drug addiction, self-inflicted injuries, and conditions resulting from war or an act of war. Policies might also have waiting periods before benefits start. Always consult your specific policy for detailed exclusions.

What are the drawbacks of long-term care insurance?

Long-term care insurance has the significant drawback of increasing premiums over time, which may become unaffordable for some seniors. Additionally, traditional LTCI does not offer a return of premium, meaning if you never require long-term care, the money you paid into the policy is lost.

What are the advantages and disadvantages of long-term care?

Advantages of long-term care insurance include comprehensive coverage for various care services, inflation protection, and potential tax benefits. Disadvantages include potentially rising premiums over time, a “use-it-or-lose-it” policy where unclaimed premiums are forfeited, and sometimes limited coverage on certain services.

Why might a younger person buy long-term care insurance?

Purchasing long-term-care insurance at a younger age can be a savvy financial decision. Premiums tend to be lower, allowing younger individuals to lock in favorable rates.

Is there an age limit to purchasing long-term care insurance?

Many insurance companies have age limits for new long-term care policies, typically around 75-85. However, some providers may make exceptions based on an individual’s health and lifestyle.

What is the best time to buy long-term care insurance?

The age factor plays a vital role in the cost of long-term care insurance. Generally, younger buyers can secure more favorable rates. However, according to industry experts, the best time to buy long-term care insurance typically lies in your mid-50s to mid-60s.

What triggers a long-term care insurance policy?

Many long-term care policies have a “loss of independence” trigger. Your policy benefits will be activated if you require assistance with a specified number of ADLs. Some policies include a specific cognitive impairment trigger, such as a diagnosis of dementia or Alzheimer’s disease. Once this trigger is met, the policy benefits kick in. A common requirement is a physician’s certification stating that you need long-term care due to a chronic illness or disability. This certification is often necessary to initiate the benefits.

What is the federal long-term care insurance program?

The United States Federal Long-Term Care Insurance Program (FLTCIP) is a voluntary insurance program available to federal employees, including uniformed service members and qualified relatives. The program provides an essential safety net that helps cover the costs of long-term care services.

What is proof of loss?

Proof of loss is a written statement that policyholders submit to their insurance company. This statement details the extent and nature of a loss they’ve suffered. If someone with long-term care insurance requires extended hospitalization, they will submit a proof of loss to detail the medical expenses and the nature of their health condition.

Does long-term care insurance pay family caregivers?

The answer varies depending on the policy. Some policies cover care family members provide, although typically with certain restrictions and conditions. For instance, the family member may need to be a licensed caregiver, or there may be limits on the compensation amount.

Who are the best candidates for self-funding long-term care costs?

The best candidates for self-funding long-term care costs are individuals with significant savings or assets, a stable income, and limited reliance on government assistance. These individuals are financially prepared to cover the high expenses associated with long-term care services out of their own pocket without depleting their resources or relying on Medicaid for assistance.

What is the biggest drawback of long-term care insurance?

The biggest drawback of long-term care insurance is its cost. Premiums can be expensive and increase over time, making them unaffordable for many. Moreover, if the policyholder never requires long-term care, they may pay for coverage they never use. Therefore, it is essential to consider the affordability and potential need for long-term care before purchasing this insurance.

What’s the cost of long-term care insurance at age 60?

At age 60, assuming you’re in good health, you might pay around $3,000 per year or $250 per month.

How much does long-term care insurance cost for a 65-year-old?

The cost of long-term care insurance for a 65-year-old varies depending on several factors, including their health, the coverage amount, and the duration. On average, premiums can range from $2,000 to $5,000 annually. It is recommended for individuals to obtain personalized quotes from insurance providers to get an accurate estimate.

How much is long-term care insurance for a 75-year-old?

The cost of long-term care insurance for a 75-year-old varies depending on factors like health, coverage amount, and policy options. A 75-year-old can expect to pay around $5,000 to $10,000 annually for long-term care insurance. However, getting personalized quotes from insurers is recommended to get an accurate estimate.

What’s the cost of long-term care insurance at age 77?

At age 77, long-term care insurance costs are higher due to the increased risk associated with age. Premiums can reach up to $6,000 per year, equivalent to $500 monthly.

What is the average cost of long-term care insurance?

The average cost of long-term care insurance varies depending on several factors, including the insured’s age, health, and the level of coverage desired. However, on average, the annual premium for long-term care insurance can range from $1,500 to $3,500.

Shawn Plummer

CEO, The Annuity Expert

Shawn Plummer is a licensed financial professional, insurance agent, and annuity broker with over 14 years of first-hand experience with annuities and insurance. Since beginning his journey in 2009, he has been pivotal in selling and educating about annuities and insurance products. Still, he has also played an instrumental role in training financial advisors for a prestigious Fortune Global 500 insurance company, Allianz. His insights and expertise have made him a sought-after voice in the industry, leading to features in renowned publications such as Time Magazine, Bloomberg, Entrepreneur, Yahoo! Finance, MSN, SmartAsset, The Simple Dollar, U.S. News and World Report, Women’s Health Magazine, and many more. Shawn’s driving ambition? To simplify retirement planning, he ensures his clients understand their choices and secure the best insurance coverage at unbeatable rates.

The Annuity Expert is an independent online insurance agency servicing consumers across the United States. The goal is to help you take the guesswork out of retirement planning and find the best insurance coverage at the cheapest rates

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