For many people in retirement, their greatest fear is ending up in a nursing home. Being able to live independently or, barring that, getting into a quality facility of his or her choice is an important end goal. Unfortunately, this type of care does not come cheap. 

According to the 2011 Genworth Cost of Care Survey, the median annual cost of a private room at an assisted living facility in the U.S. is $39,135. That same private room at a nursing home averages almost $78,000 per year. Because these costs are expected to continue rising in the years to come, it is important to have a plan to protect yourself against this potential shock to your retirement budget.

Covering the Costs of Long-term Care

There are four primary ways to pay for long-term care: Medicare, Medicaid, paying the costs yourself, or purchasing a long-term care insurance policy. Many people assume that Medicare is the answer, but it only covers long-term care expenses under very limited circumstances. Medicaid will help pay, but it is a needs based program that essentially requires you to be both sick and poor in order to be eligible for assistance. It is often a last resort for someone who needs care, but has exhausted his or her personal resources. Because Medicare and Medicaid are not great options, it is important to have alternative plans to cover the costs. Some may have the resources to self insure. For others, it may make sense to purchase a long-term care insurance policy.   

How Does Long-term Care Work?

In general, a long-term care policy pays a specific dollar amount for each day of care that is covered by the policy. Covered services can include home health care, respite care, adult day care, care in an assisted living facility, or nursing home care. The policy is usually triggered when you need help performing the normal activities of daily living, such as bathing, eating or dressing.

Roberta Hahn of Tigard, Oregon arranged for her mom Helen to get help when she began to struggle with these daily tasks. “Mom lived independently as long as she could,” Hahn said. “Physically she just got to the point where she couldn’t take care of herself anymore. Because I work, I wasn’t able to give her the kind of care she needed, so it was a relief when we were able to get her into a great facility not far from my home. Thankfully, she has a long-term care policy that has helped to cover much of the cost.”

There are nearly 10 million Americans who, like Ms. Hahn, need help with these daily tasks. As life expectancies rise, that number is expected to grow. In fact, the President’s Council of Economic Advisors estimates that 70 percent of people who reach the age of 65 will need some form of long-term care before they die.

Is a Policy Right for You?

Policies like Ms. Hahn’s can be expensive and they’re not for everyone. If you can’t afford the premiums, don’t have significant assets to protect, or Social Security is your only source of income, you will probably want to think twice before purchasing long-term care insurance. If, however, you want to preserve assets for heirs and can afford the premiums, a policy can be a wise investment. Other common reasons people have for purchasing a policy are to have peace of mind, to avoid being a burden on friends or family, to be able to get into their choice of facilities and to be cared for at home as long as possible.

What to Look for in a Policy?

If you decide that long-term insurance might make sense for your situation, there are several things you will want to consider when purchasing a policy. Does the policy you are considering exclude certain pre-existing conditions? Is there an elimination period after you enter a facility before benefits will begin to be paid? Is the insurance company offering the policy reputable and financially strong? Do benefits cap out at a certain level? Does the policy cover a broad spectrum of services from home care to assisted living and nursing home care?

Because medical costs are rising rapidly, it is also important to have a policy that offers inflation protection. You may be able to purchase one day in a nursing home in your area now for about $200, but the same day might cost you $325 ten years from now. It is generally a good idea to get a policy that compounds five percent annually. To help compare policies you are considering, be sure to ask the company for their outline of coverage, which will highlight a policy’s features, provisions and benefits. 

When and How to Apply

Qualifying for long-term care insurance becomes more difficult as you age. Because of that, the average purchase age is 57. According to the American Association for Long-Term Care Insurance, about half of those waiting until age 70 will be declined due to health reasons. A trusted insurance or investment adviser can help you evaluate your options and apply for a policy that is right for you.

As you can see, there are many different things to consider before purchasing long-term care insurance. Deciding which option is best can be complicated, but having good information and wise council will usually help the proper solutions come into focus.

FPA member Joseph R. Hearn is the Vice President at Teckmeyer Financial and author of the books If Something Happens to Me and The Bell Lap: The 8 Biggest Mistakes to Avoid as You Approach Retirement.


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