Many people mistakenly think their health insurance or Medicare will pay for any long-term care services they may need at some point. But health insurance really only pays for doctor and hospital bills. If you develop a chronic illness or become disabled and are unable to care for yourself for an extended period of time, you’ll need long-term care services. And these services aren’t cheap. Full-time nursing home care averages $69,000 to $78,000 per year or 8 hours per day of home health care can cost $43,000 to $70,000 annually.

Who Needs It?

If you can afford long-term care insurance, you should probably consider it. Why? Because the cost of long-term care, should you need it, can quickly deplete your life's savings. For instance, having a home health aide visit just three days a week can cost more than $20,000 annually. Full-time nursing home care, the most expensive type of care, now averages $69,000 to $78,000 per year. In some regions of the country, like the Northeast, the cost may be twice that amount. 

While financial considerations cannot be understated, long-term care insurance isn't only about money. It's also about peace of mind. Having it ensures you'll have access to first-rate care when you need it. It also means you won't have to be dependent on others or be a burden to your children.

What are the odds you'll need long-term care insurance? Greater than you might imagine. There's about a 70 percent chance you'll need some type of long-term care after age 65. And long-term care services are not just for older people. A young or middle-aged person who has been in an accident or suffers from a debilitating illness may very well require long-term care services. In fact, 40 percent of patients receiving long-term care are under age 65. 

If you can afford to pay for care without significantly impacting your assets, you may not need long-term care insurance. Conversely, if your assets, not including your home, are less than $80,000 if you're married (or $30,000 if you're single), you may not be able to afford the premiums. But If you're somewhere in between, long-term care insurance should be part of the discussion the next time you sit down with an advisor to review your financial plans.

How Much Does it Cost?

Long-Term care services, whether obtained in a nursing home full-time or in your house a few days a week, can cost a considerable amount. But prices vary widely throughout the country due to cost of living differences, state and local regulations and other factors.

How Do I Get Protection?

The best way to ensure that you'll have access to high-quality long-term care services is to have long-term care insurance coverage. There are two main ways to get coverage - buy it on your own or obtain it through an employer-sponsored insurance program that your company may offer. 

Some benefits also are available from the government, through Medicare and Medicaid. 

However, you should be careful about relying on government programs. Medicare covers only short-term skilled nursing home care, and Medicaid will pay for your care only if your assets are very limited. Some states have Long-Term Care Insurance Partnership Programs that allow you to buy private long-term care insurance and remain eligible for Medicaid benefits if your private insurance runs out. Read on to learn more about the various sources of protection. 

Buy It on Your Own

This is the most reliable way to cover the potential costs of long-term care while protecting your savings. You can purchase coverage from any number of companies, and there are policies and features to fit most price ranges. Because there are so many options to weigh when considering a purchase, you'll want to find an agent who specializes in long-term care insurance. That person will be able to explain the many features of long-term care insurance and help you strike the appropriate balance between the benefits you desire and the money you have to spend.

Get It through Your Employer

A growing number of employers offer group long-term care insurance as a voluntary employee benefit. Typically, an employer will contract with a particular insurance carrier and allow its employees to purchase coverage, often through automatic payroll deductions. Because employees pay for coverage out of their own pockets, the policies are almost always portable, meaning you can keep them in force if you change jobs. One potential advantage of buying through your employer is that you can sometimes get coverage that would have been more difficult to obtain on the open market. This is especially true of employees whose have health problems or a poor family health history. 

Why? Because with most group plans, employees are offered the same premium as others in their general age bracket (e.g., 45-54 year olds), regardless of their health status or actual age. So if you're an older employee or perhaps have some health issues, the one-size-fits-all premium offered through your employer may be lower than what you'd be able to obtain if you tried to get coverage on your own. A downside of buying through work is that you're limited to the companies and products that your employer makes available to you through your benefits package, and you might be able to find a better price or policy by shopping on your own.


Medicare is the federal government's program that pays healthcare bills for older Americans. When it comes to long-term care, there's a common misconception that Medicare will pay a good chunk of the cost of long-term care. Not true. Medicare only covers short-term skilled nursing home care that you receive after being hospitalized for at least three days.

For instance, if you get in a car accident, Medicare may cover your care in a rehabilitation facility for a period of up to 100 days. Medicare also pays for some skilled at-home care but only for short-term unstable medical conditions and not for the ongoing assistance that many elderly people need. Medicare will not pay for any custodial care, and 95 percent of all long-term care is custodial, not skilled. For more information, visit the Medicare Web site.


Medicaid is the federal government's program that pays healthcare bills for Americans who meet federal poverty guidelines. In addition to covering doctor visits, hospital stays and other standard medical expenses, Medicaid pays for about half of all nursing home costs in the U.S and a smaller, but growing, portion of the nation's home care costs. But remember, Medicaid will only pay for care if you have very limited assets.

Qualifications vary by state, but generally you may keep only the house in which your spouse or dependent resides, the furniture, a car, a burial plot and funeral funds, and a modest amount of cash. Having Medicaid pay for your care also means you may not have much of say in choosing the facility that will provide your care. For more information, visit the Medicaid Web site. 

Partnership Programs

The Long-Term Care Insurance Partnership Program began in the 1980s as a demonstration program in four states (California, Connecticut, Indiana and New York) to encourage people who might otherwise rely on Medicaid to buy long-term care insurance. 

Participants who deplete their policies can retain a certain amount of their assets and still qualify for Medicaid – provided they meet all the eligibility criteria. This is an important distinction. Medicaid eligibility is not automatic. To qualify, you must meet your state's income and functional eligibility requirements. A state's functional eligibility requirements for Medicaid may be stricter than those for private long-term care policies, which typically require that you be cognitively impaired or required help with two or more activities of daily living.

In 2005, Congress expanded the partnership program to allow all states to participate. At least 21 states have enacted legislation that would allow them to establish partnership programs. They are Arkansas, Colorado, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Maryland, Massachusetts, Michigan, Missouri, Montana, Nebraska, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Virginia and Washington. For more information on your state's Partnership Program, contact your state insurance department.

When Should I Buy It?

As with most kinds of personal insurance, the younger you are when you purchase long-term care insurance, the lower your premiums will be. Once you own a policy, premiums generally don't increase with age, unless an insurance company raises them for a whole class of policyholders. 

When you consider that 40 percent of those receiving long-term care are under age 65, you should at least give some thought to buying coverage when you're still relatively young. Doing so should allow you to lock in a low rate while providing you with coverage that may be needed sooner than you think. Also, be aware that most companies won't sell individual policies to people under age 18 or over age 84.

If you can't buy as much coverage as you think you need, consider buying an affordable plan now and enhancing it later when your financial situation improves.

What Types of Care are Covered?

Long-term care insurance pays for a wide range of services and procedures that typically aren't covered by a person's medical insurance. The types of care fall into three categories: skilled, intermediate and custodial. Read on to understand the differences between the various types of care.


If you have a serious illness or injury that you can recover from, you will probably receive skilled care from nurses or professional therapists. Skilled care is provided daily, usually ordered by a physician, and involves a treatment plan. In short, skilled care helps get you better.

Intermediate Care

This type of care is the same as skilled care, but not provided on a daily basis. For instance, if you injured your leg and need to visit a physical therapist five times a week to help you heal, that would be considered intermediate care.

Custodial Care

Unlike skilled and intermediate care, which is used to improve your health, custodial care isn't intended to get you better. Instead, custodial care includes assistance with daily activities like bathing, eating, dressing, toileting (getting on and off the toilet and other tasks associated with personal hygiene), continence and transferring (getting in and out of bed and chairs). Catheter or colostomy drain are other examples of custodial care. Custodial care can range from in-home care provided two or three days a week, to 24-hour nursing home care. 

Where is Care Delivered?

Many people mistakenly think long-term care is synonymous with nursing home care. A nursing home is a good example of a facility that provides long-term care services, but it's just one of the many settings in which long-term care is delivered. In many cases, care is provided in the home often by a visiting nurse or a home health aide. Long-term care services are also provided in places like assisted living facilities and adult day care centers. Because long-term care insurance policies may differ in what they cover, it's important to be familiar with the different locations where you can receive care. Below we describe the four settings in which most long-term care is delivered. 

Home Care

Home care is a simple phrase that encompasses a wide range of health and social services delivered at home to recovering, disabled, chronically ill or terminally ill persons. These services may include medical, nursing, social, or therapeutic treatment, assistance with essential activities of daily living, and even light household needs, such as shopping and cooking.

Generally, home care is appropriate whenever a person prefers to stay at home but needs ongoing care that cannot easily or effectively be provided solely by family and friends. More and more seniors, electing to live independent, non-institutionalized lives, are receiving home care services as their physical capabilities diminish. It's also a popular choice for younger adults and children coping with chronic conditions or disabilities. 

Assisted Living Facilities

Assisted living facilities are residential centers that provide continued care for those who want or need assistance performing certain daily living activities. These facilities, which are growing in popularity, generally offer personal services, 24-hour supervision and assistance, recreational activities, and health-related services. They are designed to minimize the need to move around, and typically provide residents with more privacy and independence than a nursing home setting.

Nursing Homes

Nursing homes are dedicated facilities that provide comprehensive long-term care services. Though they primarily serve the elderly, nursing homes will provide care to people of all ages who are in need of extended long-term care services. The goal of care in a nursing facility is to help individuals meet their daily physical, social, medical, and psychological needs in a controlled setting.

Nursing homes generally provide around-the-clock care and may offer medical, rehabilitative, personal and residential services. But all this care comes at a price: nursing homes currently average $69,000 to $78,000 per year, and that cost can more than double in certain regions. Prices and services often vary by location and facility, so it pays to shop around for the facility that meets your needs and budget.

Adult Day Care

Adult day care centers are community-based programs designed to meet the needs of functionally or cognitively impaired adults. These structured, comprehensive programs provide a variety of health, social, and other related support services in a protective setting during daytime hours.

Most programs operate during the week, and can be attended full or part-time. Some programs offer services in the evenings and on 

Key Terms

When evaluating a long-term care insurance policy, here are important terms with which you should be familiar.

Benefit amount and duration

Most long-term care policies are set up as indemnity plans, which means they pay a fixed dollar amount for each day you receive care. Policyholders usually have a choice of daily benefit amounts ranging from $50 to $300 or more, and can also choose the length of time that benefits will be paid. Long-term care policies generally limit benefits to a maximum dollar amount or a maximum number of days and may have separate benefit limits for nursing home, assisted living facility, and home health care within the same policy. For example, a policy may offer $100 per day up to five years of nursing home coverage (many policies now offer lifetime nursing home coverage) and only up to $80 per day up to five years of home assisted living and health care coverage.

Elimination or deductible periods

These terms refer to how many days you must spend in a nursing home or how many home health visits you must receive before benefits begin. Most policies offer a choice of deductible from zero to 100 days. The longer the elimination or deductible period, the lower the premium. 


When you apply for a policy, you'll be asked to fill out a medical questionnaire, and probably undergo a check-up with a doctor. This helps the insurance company find out about any existing health issues (known as preexisting conditions) that make it more likely that you'll one day need long-term care. Preexisting conditions may make coverage more expensive, and the insurance company may choose not to cover you for these conditions during your first six months of coverage. 

Inflation protection

Because long-term care prices are rising steadily, the benefit you buy today may be inadequate tomorrow. By purchasing inflation protection, your policy benefit will automatically increase each year at a specified rate (such as 5 percent) compounded over the life of the policy. 

Nonforfeiture benefits

This feature allows you to drop your coverage and still receive a portion of the benefits. Nonforfeiture benefits may be received two ways, depending on the policy and option you choose. Return of premium provides a cash payment that is a percentage of the total premiums you have paid. With a shortened benefit period, you still receive coverage after you've stopped paying, but with a reduced benefit period or amount. 


Almost all long-term care policies are guaranteed renewable. That means that they cannot be canceled as long as you pay your premiums. However, companies can raise premiums as long as they raise them for an entire class of policyholders. The renewability provision, usually found on the first page of the policy, outlines under what conditions the company can cancel the policy or raise premiums. 

Waiver of premium

This provision allows you to stop paying premiums while you are receiving benefits. Your policy may contain restrictions on this feature, such as requiring you to receive care for a certain number of days or sessions before premiums are waived. 

*Long Term Care Insurance Information courtesy of Life and Health Insurance Foundation for Education.