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by Tanza Loudenback
September 24, 2020
by Tanza Loudenback
September 24, 2020
Healthcare is the largest expense most retirees face.
Medicare doesn't cover everything, including most long-term care needs, so many Americans are forced to drain their own savings, lean on family and friends, or use private insurance to afford daily assistance if they need it.
As of 2016, a semi-private room in a nursing home costs, on average, $6,845 a month, according to the US Department of Health and Human Services, while a completely private room will set you back about $7,700 a month. A one-bedroom unit in an assisted living facility costs around $3,630 a month and an in-home health aide charges about $20.50 an hour, on average.
Even if these costs seem manageable at face value, they can add up tremendously. Researchers from the Urban Institute estimate that more than half of Americans over age 65 will develop a disability that requires long-term care for two years or less at an average total cost of $138,000. About one in seven adults, they found, would need care for more than five years.
Long-term care insurance can help minimize these costs.
Long-term care (assistance beyond 100 days) is generally not covered by Medicare because it's considered custodial care and not medical care. While Medicaid does cover long-term care for millions of Americans, there's a low-income threshold to qualify.
Long-term care (LTC) insurance can help retirees who don't want to spend down their assets to qualify for Medicaid afford the cost of an in-home caretaker, or a stay at an assisted-living facility, skilled nursing facility, or nursing home.
Like all other forms of insurance, once you buy an LTC policy and begin paying the monthly premium, you become entitled to the benefits.
Coverage on most LTC insurance policies kicks in once the policyholder needs help with two or more of the six Activities of Daily Living (ADLs): eating, bathing, dressing, transferring, using the toilet, and maintaining continence. Severe cognitive impairment that increases the policyholder's health and safety risk also qualifies.
Each policy has an elimination period, which states the number of days the insured must wait to receive benefits after the insurer determines they're eligible. A typical elimination period is 30, 60, or 90 days.
The amount of money the policyholder will be reimbursed for is known as the daily limit. This is outlined in the policy and usually around $150 a day or more. The insurer will continue paying the daily benefit up to a maximum number of days, typically a period between two years and 10 years, or up to a specified amount of money.
It's difficult to know whether or not a person will need long-term care in their later years, just as it's impossible to predict whether a person will ever need to draw on the benefits of homeowners insurance or life insurance. But if you're concerned about the costs of elder care and know your own savings or help from family won't cover it, it's a good idea to get long-term care insurance.
According to the US Department of Health and Human Services, those most likely to need long-term care are women, because they statistically outlive men and in many cases wind up at home alone; people with chronic illnesses that lead to disability; people with a poor family health history; people with poor diet and exercise habits; and people with a chronic condition like diabetes or high blood pressure.
The longer you wait to buy long-term care insurance, the more expensive it is. Insurers determine premiums based on age, health, the type of policy, benefit period, and coverage amount. The American Association for Long-Term Care Insurance recommends buying a policy between ages 52 and 64 for the best rates.
A single male in good health will pay about $2,050 year, on average, while a single female will pay $2,700 annually, according to the organization's data. For a couple aged 55, the average annual premium is around $3,050.
It's important to note that insurers reserve the right to increase your premium after you buy the policy, as long as they do it for all policyholders in the same classification.
People who already need help with any qualifying daily activities, have had a stroke in the last several years, or have dementia, a progressive neurological condition, AIDS, or metastatic cancer may be denied long-term care insurance.
Most LTC insurance policies are sold by about 15 to 20 insurers nationally, according to the US Department of Health and Human Services. It pays to shop around and compare quotes online, but be sure to always check an insurance company's ratings before buying a policy to get an idea of its claims payout history and track record.
LTC insurance can get complicated, so you may considering getting help from an insurance broker or certified financial planner to make sure you're choosing the right policy for your needs.
Your employer may also offer long-term care insurance at a group rate, which is often cheaper than the cost of an individual policy.