Most households would benefit from having some long-term care (LTC) insurance other than those that are sufficiently rich or sufficiently poor. Rich households can self-insure and pay for long-term care out of pocket. A reasonable rule of thumb is that the household has $500K-$1M per retiree that they can earmark specifically for LTC. If so, they don’t need LTC insurance. Poor households can generally rely on Medicaid if their income is less than $2742 per month (which will increase with inflation over time). Anyone with income (including social security benefits) above this threshold will likely not qualify for Medicaid.

When purchasing long-term care insurance, there are a few important considerations:
1. Buy a policy with inflation protection as LTC costs are likely to increase over time.
2. Buy from a reputable insurer with good credit & consumer ratings plus a history of premia stability. Two solid insurance companies for long-term care are Northwestern Mutual and NY Life. I have no affiliation to either company.
3. Buy a policy with reimbursement payment (to cover care expenses) not indemnity or cash benefits, as premia are cheaper this way.
4. Avoid LTC insurance bundled with life insurance. It is generally cheaper to buy standalone long-term care insurance separate from death & withdrawal benefits.
5. The ideal ages for buying LTC insurance are in one’s 50s and 60s, as LTC insurers can reject applications for health reasons.

LTC insurance (e.g., from the aforementioned companies) is expensive, but so too is long-term care. One way to make it more affordable is by adding an elimination period (like a deductible for health insurance) which is the period during which you’d pay LTC out-of-pocket before benefits kick in. Another way to make it more affordable is by buying a policy with “inflation offers”. In this case, your premium isn’t fixed but increases with the rate of inflation as do your benefits.

FYI the current premium is around $9K per year ($750 per month) for a 50-year old male with a $12K monthly benefit, total max benefit of $1M, benefits increasing at 3% compound inflation per year, and a one-year elimination period. The premium goes down to about $4K per year ($300 per month) with a CPI-based inflation offers policy and all other features the same.

FYI I am not affiliated with any insurance company, nor do I make any money from insurance sales. I work for a company that does financial planning for retirement with a focus on long-term care. I’ve got LTC insurance to protect my spouse and children from the burden of my care in the future even though I, too, would like to avoid those years if at all possible.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

I know several men who have told me that is their plan. They might not realize they won’t be able to carry it out

It's such a disingenuous, faux-macho quip. "Just shoot me; I'm not going into a nursing home..." Guess what? You don't get to decide anymore when you are mentally absent. And because you pretended that you wouldn't need any nursing home/dementia care, macho-man-you didn't save or plan for it. And when you do need it, your wife or kids are going to have to use all their money and yours to pay for it.

Just stop with the macho-man routine and save your pennies.

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

I know several men who have told me that is their plan. They might not realize they won’t be able to carry it out

Do not buy it. The long-term care insurance market is structurally insolvent because genetic testing now allows people to have better information about their risk level and purchase insurance accordingly. Millions of Americans have received 23&Me results about APOE4(Alzheimer's risk gene) carrier status and assuming even a small fraction of them act on this information it will bankrupt these insurance companies in the long-run. Premiums will need to go up or benefits will not be paid in full to compensate for this imbalance. IMO, it will end up being a waste of money and it is better to attempt to self-insure by saving more money instead.

Anonymous wrote:

Anonymous wrote:
Not worth getting. We do not have it. Like another poster, we would prefer to succumb to whatever illness leaves us needing that kind of care. We have seen it and it's not a life we would want at any price.

Signed,
retired people in late 60's

I don't understand these types of comments. NOBODY WANTS to go into dementia care facilities. But if you become too much for your 80 yr old spouse to care for 24 hrs/day, 7 days/week, THEY are going to put you in a facility, and you better have some $$$$$ to pay for it.

Are you suggesting that if you have dementia, you are going to take yourself out? If not, then you don't get to just decide that you are going to "succumb" to dementia or Parkinsons. Your relatives/spouse have to deal with your needs until you eventually "succumb" -- which may be 3-10 yrs. They may not be willing to change your diapers. They may prefer to put you in a facility where you can't wander out the door at 2 a.m. in the freezing cold winter. Gotta have $$$$$.

+100. You’d better have a pill ready if that’s your plan. Otherwise get ready to pay. My elderly father has Parkinson’s and was falling multiple times a week. He’s already in a very nice Assisted Living but needed eyes on him 24/7 and we hired a private aide. Cost was over $300k A YEAR. The alternative sure was to put him in a sad nursing home home where they would warehouse him to a wheelchair, he’d resist, he’d fall, then he’d be in a wheelchair and it would all be downhill from there. If he didn’t have a massive stroke from all of that.

Luckily he improved and we’re back to just the $80k/yr AL facility. But imagine how fast even a decent estate is going to go at the rate of $300k/year.

I’m not advocating for LTC insurance bc I’ve heard shitty things about it, just saying this health system we have is really effed up.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

There is no legal/legitimate "medical directive" that would allow a caregiver/spouse/relative or even the state to simply turn their back on a dementia patient and let them die of neglect. Not going to happen.

I think there is a percentage of people who like to talk REAL BIG about how they are going to be IN CONTROL and not live in any kind of diminished capacity. They like to talk big, but when the time comes and they actually have dementia, they are going to need the same care that everyone else needs... toilet care, dressing, help with managing life, and security so they don't wander away. The bottom line is that there is no easy way out of living through dementia unless you have a pact with your spouse to do a murder-suicide.

I think that's fair. I will say the directive I looked at did specify euthanasia as a desire if legal.

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

There is no legal/legitimate "medical directive" that would allow a caregiver/spouse/relative or even the state to simply turn their back on a dementia patient and let them die of neglect. Not going to happen.

I think there is a percentage of people who like to talk REAL BIG about how they are going to be IN CONTROL and not live in any kind of diminished capacity. They like to talk big, but when the time comes and they actually have dementia, they are going to need the same care that everyone else needs... toilet care, dressing, help with managing life, and security so they don't wander away. The bottom line is that there is no easy way out of living through dementia unless you have a pact with your spouse to do a murder-suicide.

Anonymous wrote:

Anonymous wrote:My parent has LtC insurance. They are going on the 5th year of assisted living. Policy had paid in full per all years. They have no elimination period and the policy pays for lifetime. Has worked well with no issues. Parent in their 90s. Glad they gave it.

Yes but you and I can’t get a great policy like that now.

Agreed. These policies no longer exist.

Anonymous wrote:My parent has LtC insurance. They are going on the 5th year of assisted living. Policy had paid in full per all years. They have no elimination period and the policy pays for lifetime. Has worked well with no issues. Parent in their 90s. Glad they gave it.

Yes but you and I can’t get a great policy like that now.

My parent has LtC insurance. They are going on the 5th year of assisted living. Policy had paid in full per all years. They have no elimination period and the policy pays for lifetime. Has worked well with no issues. Parent in their 90s. Glad they gave it.

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

What do his directives actually say? People can live for 5, 10, or 20 years with dementia. You going to lock him in the basement until he starves to death?

Anonymous wrote:

Anonymous wrote:No, I plan to self insure. I also have no interest in wasting away in diapers in a $15,009 a month memory care unit. Just OD me.

Yeah um, if this is what you really want, then you need to write a super tight "do not rescucitate" will now and one that says that if you can't feed, bathe and cloth yourself, then you do not want to be offered any food or otherwise. The point, by the time you're losing it with dementia or through a fall or something else, you won't be able to assert these types of rights yourself and it's illegal for your friends and relatives to do this for you.

Is it even permissible to have a DNR for when you are a dementia patient but not otherwise terminally ill? It's one thing to stop feeding someone in the hospice who isn't able to feed themselves let alone get out of bed. But many dementia patients are physically mobile and can live for many years like that. If you don't feed them, they're going to come looking for food unless you have them handcuffed to the radiator or something. Having a ward full of dementia patients who are slowly starving to death sounds like a horror movie. What kind of Nazis would you need to run such a place?

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

Do you have a spouse and if so what do they think? What happens if you're cognizant and enjoying life but can't complete some daily living tasks and need care? Or your spouse is in that situation? After my grandfathers died, both my grandmothers needed to be in long term care due to repeated falls, but they still loved seeing their grandchildren, playing cards with their friends etc. Basically their kids coughed up the money for their long term care--and none of them are well-off but there are at least 5 kids in each family to share the burden-- because my grandfathers ran the finances and didn't think about it.

I would definitely qualify what you describe as "enjoying the basic things in life". And part of the reason I have no desire to have big sums of money spent on me is so that my wife has more money available in the actuarially likely event she outlives me. We are maximizing retirement savings partially to cover things like this.

Anonymous wrote:

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.

Do you have a spouse and if so what do they think? What happens if you're cognizant and enjoying life but can't complete some daily living tasks and need care? Or your spouse is in that situation? After my grandfathers died, both my grandmothers needed to be in long term care due to repeated falls, but they still loved seeing their grandchildren, playing cards with their friends etc. Basically their kids coughed up the money for their long term care--and none of them are well-off but there are at least 5 kids in each family to share the burden-- because my grandfathers ran the finances and didn't think about it.

Anonymous wrote:

So it rubs me really wrong when the older spouse--usually male--with a shorter life expectancy--again usually male--makes a solo decision to not plan for this reasonably without really working through the details of the various situations with their spouse.

Very likely it's not men here on DCUM who keep saying "forget LTC insurance, let me die or get euthanized."

One man here who mostly feels that way. Zero desire to live to a point where I can't enjoy the basic things in life, or have no idea who my family is. My father has made clear he feels the same way, and has made it very clear in his medical directives.