Few Americans prepared to cover long-term care costs

While many Americans will need long-term care as they get older, few are prepared to pay for it.

Medicare, which provides Americans over the age 65 with health insurance, doesn't cover most long-term care services. And Medicaid — the primary safety net for long-term care coverage — only covers those who are indigent.

Federal estimates suggest 70% of people ages 65 and older will need long-term care before they die, but only 3% to 4% of Americans age 50 and older are paying for long-term care policies, according to insurance industry figures.

The high cost of premiums for those private long-term care policies puts it out of reach for most people.

Even some who have this kind of insurance find it doesn't provide enough to cover the costs of home health aides, assisted-living facilities or nursing homes.

"People think that long-term care insurance is for everyone — but it is not," said Jessie Slone, executive director of the American Association for Long-term Care Insurance, an advocacy group. "It's for a very small subset of individuals who plan, and have some retirement assets and income they can use to pay for it."

To qualify, applicants need to pass a health review. Slone said insurance companies have underwriting policies with "page after page" of conditions that will disqualify people from getting that coverage. "If you live a long life, the chances of you needing care are significant. So then the issue becomes who's going to provide for that care, and who's going to pay for it. For some, long-term care insurance is an option."

Prices vary, based on the age when people apply, how good their health is at the time, and how much coverage they want. "You have to start looking at this generally in your 50s or 60s," Slone said. "Because, as you get older, you're going to have conditions which insurers are going to look at, determine that you're very likely to need long-term care and not give you a policy."

That coverage, if you can get it, doesn't come cheap: In 2023, the annual average cost for a policy for a couple both age 55, taking out a $165,000 initial pool growing at 3% compounded annually — ranged from a low of $5,018 to $14,695 a year, according to the association.

But, compared to auto insurance — which most people may never use — long-term care insurance is a good investment for those who can afford it, Slone said. "Car insurance is the most expensive insurance you ever pay because the chances of you getting into a car accident are somewhat remote. But the chances of someone needing long-term care if they make it to 90 are pretty significant."

Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a national nonprofit advocacy group, views it differently. She said the private long-term care insurance system has become a "bust" amid rising premiums and difficulties accessing benefits.

Consider the fact that the number of companies offering long-term care insurance is declining, while payouts are steadily increasing as the baby boomer generation ages. "Most people have found it very expensive," Smetanka said. "But, at the same time, people are finding that it wasn't covering what they needed."

Last year, insurers paid a record of more than $14 billion to cover an estimated 353,000 long-term care claims, according to industry figures. That's compared to about $11.6 billion just three years ago.

Currently, there are about 7.5 million people in the U.S. age 65 and older with private long-term care insurance, according to industry data.

With that incentive, some states, including Washington and California, are looking at creating long-term care social insurance pools funded by payroll taxes and other sources of funding. The effort also is being spurred, in part, by the rising costs borne by states for Medicaid long-term care coverage, which they share with the federal government.

"More and more states are coming to the conclusion that this is an under-funded system," said Marc Cohen, a researcher and co-director of the LeadingAge LTSS Center at the University of Massachusetts at Boston. "There are simply not enough dollars going into the system – given the needs and the demands of the growing elderly population."

So far, Washington is the only state to try to address the issue. A law approved by the state Legislature in 2019 created a long-term care benefit program, which provides residents with up to $36,500 to pay for costs such as caregiving, wheelchair ramps, meal deliveries and nursing home fees.

The Cares Funds is covered by a payroll tax that deducts 0.58% out of paychecks but guarantees a $36,500 lifetime benefit for those who have paid into the fund for 10 years.

Several other states are studying the issue. In California, a task force is looking at how to design a long-term care program, according to the National Conference of State Legislatures. Massachusetts, Illinois and Michigan also are weighing the costs versus benefits of creating a state long-term care benefits program.

But the issue of imposing new taxes to pay for long-term care insurance is controversial — and politically unpopular — on both a state and federal level.

Washington's long-term care insurance law is facing a repeal effort from a group backed by hedge fund executive Brian Heywood that argues the system should be voluntary. Voters in November will decide whether to allow people to opt out, which supporters say would essentially gut the program.

"There are a lot of states that are looking to see what happens in Washington," Cohen said. "If this billionaire who is funding this repeal effort wins, it will be a real blow."

Cohen said efforts on a federal level to create a publicly funded insurance pool haven't gained much traction. A long-term care program created by Congress through the CLASS Plan, which was tied to the Affordable Care Act, was voluntary. That law was repealed in early 2013.

"It never got off the ground before it was repealed," he said. "With the dysfunction in Congress, we're likely to see more action on a state level than the federal."

Recent polls suggest there may be some public support for the move. A survey by the National Council on Aging found more than 90% of the 1,000 female respondents across party lines support the idea of creating a government program to pay for the cost of long-term care.

"The level of support was significant, and very bipartisan," said Howard Bedlin, a long-term care expert with the council. "People keep talking about how Congress can't find bipartisan support. Well, the voters clearly support it.

"The politicians just aren't giving these issues the attention they deserve."