Note:  Blog post updated May 2020 

Luckily, you aren't going to need years and years of high cost long-term care. But what if you did?

Like a reverse lottery, there are some people who do require long-term care that lasts a long, long time and can costs hundreds of thousands of dollars - even cracking the million dollar mark. The odds of this happening are low, and the average person will not need this level or length of care.

As a financial advisor helping someone plan for long-term care, it is very hard to predict the future cost and duration of nursing home, assisted living , and home health care . The daily or monthly cost of care is difficult enough to estimate - not to mention the expected duration of care!

The first complexity is estimating the cost of care. Currently, the common practice is to design a plan based around the cost of home and assisted living care instead of nursing home care. The reason - a majority of LTC claims now start at home or assisted living.

Several sources give updated long-term care cost data. An excellent version is available from Mutual of Omaha and can be found at https://www.mutualofomaha.com/long-term-care-insurance/calculator. For 2021, the survey shows that the average national cost for home health care is $226.40 per day, increasing at five year annual growth rate of around 3%. Many experts think that cost trends in care, such as a labor shortage due to immigration restrictions, an aging population, and less money from government sources will have costs increasing in the future. 

After estimating the monthly cost of care, our next challenge is to determine the duration and odds of needing care - a much harder number to predict. One guidepost is to look at actual carrier experience. According to the 2017 Broker World Milliman LTCI Survey, the average carrier claim amount since inception is $37,000 for home care, $42,000 for nursing home care, and $68,000 for assisted living. Before someone comes to the conclusion that they can should plan for that amount, consider a few of things. First, some claimants may have received benefits in more than one location - going from home care to a nursing home, for example. In addition, about 15% of the claims are still open. Finally, remember statistics classes and don't confuse "average" with median - many, many LTC claims are for a short period of time and bring down the average claim number.

Another source for predicting the odds and duration of care are from academic and government research. In 2005, a study by Alliance For Health Policy showed that of people turning 65, 79% of woman, 58% of men, and 69% of all ages will need care. The average number of years of care is 3.7 years for woman, 2.2 years for men, and 3 years over all. However, the same study shows almost 28% of woman and 11% of men would need care longer than 5 years!

What other sources of information tell us about the likely spending on long-term care? A more recent study was led by Michael Hurd and Susann Rohwedder of  the RAND corporation. In studying this topic they state the obvious: "Reliable estimates of the lifetime risk of nursing home use and of the associated out-of-pocket costs are important to individuals and households in deciding whether to purchase long-term care insurance and how much to save."

The study focuses on Nursing Home Care only and what the expected costs would be for someone between the ages of 50 and 55.  Although most people who enter a nursing home only spend a few days, 10% will spend and average of 3 years - and 5% will spend over 4 years in a nursing home.  The out of pocket costs (not counting care covered by Medicare or Medicaid) for that tail risk can be substantial - over $150,000.  (To hear directly from the authors of the studies, please check out the conversation we did with them in October 2017 during our monthly webinar, This Month in LTC Planning.)

Now let's consider options for planning for care through LTC Insurance by comparing the premium costs for unlimited duration coverage versus coverage that has a benefit limit. We will look at two products -   a traditional standalone product and a Hybrid Life/LTC plan, both with annual pay premiums.  Both policies are sold by Mutual insurers with strong financial ratings.

For the purposes of this comparison we'll look at a 50 year old couple. They are looking for an initial care benefit of $5,000 per month increasing at 3% compound inflation. (We picked those benefits based on the cost of care survey data mentioned above.)

First, a look at the LTC Insurance premiums for a capped, yet substantial, benefit.

 Now, consider similar monthly LTC benefits with a lifetime benefit period.

A couple of things to point out.

First, the hybrid Life/LTC premiums are more expensive than the standalone LTC coverage because hybrid plans include things such a life insurance benefit, guaranteed premiums, and potential cash surrender values.  Our comparison here assumes someone goes on claim on age 85, which will accelerate the death benefit and reduce any cash value quickly.  Of course, for someone who never uses the LTC benefit, the hybrid plans offer a death benefit to beneficiaries. (More on the choosing between standalone and hybrid plans).

Secondly, the percentage of premium difference for the standalone coverage between a limited benefit period and lifetime is greater than for the hybrid life/ltc plans.  Again, this makes sense since all the premium on the standalone coverage is geared towards the LTC benefit versus the hybrid products.

Does the premium difference make sense in these scenarios?  It depends.  For the standalone option, because our hypothetical clients are buying when they are relatively young (50 years old), the automatic inflation included will increase the benefit to almost a million dollars by age 85.

A good rule of thumb for premium affordability is that for a 50 year old couple, often faced with competing priorities such as paying for college and saving for retirement, should pay about 2% of annual household income for standalone LTC premiums.  If a couple has a household income of $150,000, than our proposed $3,000 annual premium is right in line.  On the other hand, if the client has a household income of $250,000, it might make sense to pay the higher premium for lifetime coverage.  For people who buy policies later in life they probably will need to adjust higher the percentage of their income they use for LTC premiums.

What about the hybrid life/ltc option? In my opinion, the decision to add lifetime coverage is easier.  For this particular carrier, it is a fairly small premium increase to add the lifetime benefit option.

Many carriers no longer offer the lifetime coverage option, but some carriers still are comfortable making plans available.  For a deeper dive into why some carriers are comfortable with this option, check out a recording of this webinar featuring  Marc Glickman of LifeCare Assurance and Dennis Martin of OneAmerica.  You can view the recording at this link: Insuring the Tail Risk: A Deep-dive into Lifetime Benefits LTCI Coverage.

Unlimited benefit options are not inexpensive and are more suitable for younger, more affluent buyers.  However, they can provide great piece of mind for an uncertain future.