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In 2015, Americans spent $225 billion on long-term care. That’s 7 ½ times what was spent 15 years prior, in 2000. With the great advances we have made in medicine and medical technology, people are living longer. The downside to that is that it means people are more likely to need care and need it longer. In fact, over half of people turning 65 will need long-term care at some point in their lives.(1)

Types Of Long-Term Care

When you think of long-term care, skilled nursing facilities are probably what comes to mind. However, that is actually the last step in the long-term care journey. Most long-term care is not medical; it is simply assistance with basic activities of daily living like bathing, dressing, eating, and going to the bathroom.

Even without serious medical problems, most people become less and less capable of taking care of themselves as they age. Traditionally, people would turn to family for help with such things. However, in our modern era where families live far apart and adult children are already overburdened with careers and children, more and more people have to pay for long-term care services.

The most basic, and least expensive, form of care is homemaker services. Homemaker services do not involve anything medical, but rather things like meal preparation, cleaning, and running errands. The next step up, which does have a medical component, would be a home health aide.

Once basic in-home assistance is not enough, specialized facilities are needed. Care outside of the home can be in the form of adult day healthcare, assisted living facilities, and nursing homes.

Costs Of Long-Term Care(2)

Costs vary depending on the type of care needed and the part of the country in which you live. On an annual basis, the national average goes from just under $48,000 for homemaker services to over $97,000 for a private room in a nursing home, and that number is growing about 3-4% a year.

Things change drastically when you look at specific locations. In San Francisco, homemaker services are more than 150% the national average and growing twice as fast. A private room in a nursing home averages $171,185 a year. Even downgrading to a semi-private room still costs over $141,000 a year. Twenty years from now, that same semi-private room is expected to cost over a quarter of a million dollars.

As you can see, long-term care can be very expensive, especially with the rise of dementia, where people can live a long time while needing care. In 2018, the estimated lifetime cost of care for someone with dementia is $341,840,(3) and it’s probably much higher in a state like California.

Ways Of Paying For Long-Term Care

Because of the high cost, it is important to plan ahead for long-term care. There are a number of ways to pay for care, each with its advantages and disadvantages.

Medicaid

The vast majority of Americans turn to Medicaid for their long-term care expenses. However, it’s not because it’s a great option. Rather, it’s their only option. In order to qualify for Medicaid, you have to have a low income and low assets, so it’s not really something people plan for intentionally.

Self-Insure

On the opposite end of the spectrum from the people that can qualify for Medicaid are those who have amassed enough wealth to self-insure. If you have $50 million in assets, you can afford to pay $170,000 a year for a nursing home and it won’t have a significant impact on your finances.

The danger is that sometimes people take too great a risk thinking they can self-insure. Often, care is needed later in retirement when savings have already been spent down significantly. Having $500,000 in the bank may seem like a lot of money, but long-term care expenses can eat through it very quickly. Unfortunately, it’s not uncommon for a couple to spend all of their savings on the husband’s care only to leave the wife destitute at his passing.

Life Insurance With A Long-Term Care Rider

One option for those that find themselves in between broke and very wealthy is adding a long-term care rider to their life insurance. If you have, or are planning on purchasing, permanent life insurance, your policy may allow you to add a rider that would help pay for your long-term care costs. Using the long-term care option will often lower your death benefit, but many people appreciate knowing they will receive a benefit even if they never need long-term care.

Premium Paying Long-Term Care Insurance

Another option is buying pure long-term care insurance. Like with most kinds of insurance, you pay a regular premium in exchange for receiving a benefit when you need long-term care. One downside to this for many people is that you will only receive a benefit if you end up needing long-term care. As with car insurance where you have to get into an accident in order to get money out of it, if you never need care, you never see your money again.

Asset-Based Long-Term Care Insurance

The final option has been the fastest growing long-term care option over the last decade.(4) It is a combination of long-term care insurance and single premium life insurance, commonly called asset-based insurance.

The way it works is that you pay a large amount up front and then low annual premiums. You have several times your initial deposit available tax-free for long-term care needs. If you never use it or cancel your plan, you usually get your deposit back plus interest. Some plans even include tax-free death benefits.

Choosing A Long-Term Care Option

Looking at the statistics, you can tell that planning for long-term care is an important thing to do. Failing to do so can be a costly mistake. Because the multitude of options available can be complex and confusing, it’s important to work with an experienced financial professional.

An experienced advisor can explain all of your options to you, help you consider the pros and cons of each, and decide which is the best solution for your particular situation. If you want that kind of help choosing a long-term care option, call my office at (949) 221-8105 x 2128, or email me at michael.loo@lpl.com to set up a no-strings-attached meeting.

(1) https://www.morningstar.com/articles/879494/75-mustknow-statistics-about-longterm-care-2018-ed.html

(2) https://www.genworth.com/aging-and-you/finances/cost-of-care.html

(3) https://www.morningstar.com/articles/879494/75-mustknow-statistics-about-longterm-care-2018-ed.html

(4) https://www.525longtermcare.com/asset-based-ltci/

Generally, people purchase life insurance because they have a spouse or child they want to protect financially in case they pass away. But, there are several other reasons to buy life insurance that can benefit more than just those who need to protect their family. One of those benefits is accumulating tax-deferred, tax-free, cash value.  Just like a Roth IRA, the cash value in a permanent life insurance policy can grow on a tax-deferred status and be accessed tax-free, but without the consequence of incurring a 10% penalty if accessed before attaining age 59.5. “Living Benefits”, also known as “Accelerated Benefit Riders” are another advantage of life insurance other than the death benefit. As the name suggests, “living benefits” can be utilized in certain circumstances by the policy holder without passing away.

Common living benefits allow the policy holder to access all or some of the death benefit of their policy to help provide managed care if they are diagnosed with a critical or chronic illness. ABRs originated in the 80s and 90s when companies called “viaticals” found a market for purchasing life insurance policies from people that were very sick who realized they needed money now to help pay their medical bills more than their beneficiaries needed the death benefit. The insurance industry realized what was happening and started adapting policies to include Accelerated Benefit Riders to help their consumers get access to expensive medical care, outside of what health care would cover, while they were sick.

Living Benefits that are common today are terminal, chronic and critical illness or critical injury riders. It is important to talk to your advisor and read the fine print when considering different insurance policies because riders can differ significantly between insurance companies and policies. Terminal illness riders will allow the insured to accelerate a portion of their death benefit, tax-free if they are diagnosed with a terminal illness. Some companies require a diagnosis of 24 months or less to live while others require 12 months or less to live. A chronic illness rider is generally triggered when the insured has a long-term illness in which they are unable to perform two of the six “Activities of Daily Living” including eating, dressing, toileting, transferring, bathing, and maintaining continence. Some companies structure these riders to pay a large benefit upfront and some will provide a much smaller amount but spread over a long period of time. Lastly, critical illness/injury can include many things – heart attacks, stroke, cancer, brain trauma, severe burns etc. and the amount of benefit that is paid out depends on how critical the injury/illness is and how much it will affect the insured’s life span.

Because medicine and medical technology have advanced so rapidly, people are living much longer lives than they used to live. The US Census Bureau reports that at least 70% of people over age 65 will require some long-term care at some point in their lives . In 2014, the annual rate for a skilled nursing facility was $95,707 .  Because traditional, stand-alone Long-Term Care policies can be incredibly expensive, utilizing life insurance can be a great way to build assets throughout your income-earning years that are earmarked for advanced medical costs later on and can protect yourself and your loved ones from unknown health scares.

Riders are additional guarantee options that are available to an annuity or life insurance contract holder. While some riders are part of an existing contract, many others may carry additional fees, charges and restrictions, and the policy holder should review their contract carefully before purchasing. Guarantees are based on the claims paying ability of the issuing insurance company. Withdrawals from the policy may result in the reduction of the death benefit.

1. US Census Bureau, American Community Survey 2013
2. Univita Cost of Care Survey, Feb 2014