2022’s Top Long-Term Care Insurance Options
An UPDATED article for 2023 is published here: Top Choices for Long-Term Care Insurance in 2023
Long-term health care is now a household issue that affects families throughout the United States and worldwide. The COVID-19 virus crisis has made long-term care even more complicated.
The problem is not new, however. Medical science advances and longevity increase the number of people who need help with daily living activities and supervision due to Alzheimer's and other dementias.
Long-Term Care Insurance has been a solution that millions of people have selected to protect their income and assets from the costs and burdens of declining health and aging. In 2021 alone, the top insurance companies paid over $12.3 Billion in benefits helping families keep their loved ones at home or access quality long-term care facilities.
See our review of the top Long-Term Care Insurance options for 2022 below
Without Long-Term Care Insurance, you would be responsible for paying for costly professional long-term health care services. Health insurance, including Medicare and supplements, only pays for a short period of skilled services. Most people who require long-term health care need help with daily living activities or supervision due to memory loss - referred to as custodial care. Don't expect health insurance or Medicare to be the solution.
Medicaid will pay for long-term care services, but you must have little or no income and assets to qualify for benefits.
The bottom line is that you are responsible for paying for long-term health care services - or your family will become caregivers.
The consequences of long-term health care are more than just a financial problem. Family caregiving is demanding both physically and emotionally. It is tough to juggle the role of caregiver with a career and other family responsibilities.
Unless you own Long-Term Care Insurance, the financial and family burdens are on you and your family. How do you shop for the right coverage? Which company is best? Isn't Long-Term Care Insurance expensive? Does LTC Insurance pay for in-home care?
Who Needs Long-Term Care Insurance?
Not everyone needs Long-Term Care Insurance, but everyone needs a plan to address the problem. If you have less than $50,000 and do not own real estate, you will easily qualify for Medicaid's long-term care benefit.
If you own your home but have less than $100,000 of savings, Long-Term Care Insurance may still not be appropriate, depending on how you will be funding your retirement. Those who will have a defined pension and will not have to depend on their savings and social security of retirement income could benefit from owning Long-Term Care Insurance.
The more assets you have, the more critical the guaranteed tax-free benefits from a Long-Term Care Insurance becomes as a way to safeguard income and assets. If you have more than $5 million in assets, you could consider self-funding your future long-term health care; however, many very wealthy people decide writing a small check is better than writing a big check.
Long-term health care costs are rising rapidly due to increased demand for services and higher labor costs. The problem is that you do not know when you will need care or how the markets may be performing at that time. Self-funding is problematic and still requires you to use your own money.
Selling off stocks, mutual funds, bonds, etc., creates tax issues. In addition to using your own money, your cost could be more considering the impact of taxes and selling off assets at the wrong time.
Self-funding does not address the consequences placed on your adult children and spouse. Even if they are not caregivers, someone will have to manage the situation, find caregivers and facilities, and decide which accounts to liquidate to pay for the care. Your family may not make the same decisions as you would regarding the type of care and how to fund the care.
Long-term care is a cash flow problem, but it is also a family problem. It is hard enough to deal with a loved one with declining health. LTC Insurance helps address both issues.
Long-Term Care Insurance can provide you with guaranteed tax-free resources to pay for your choice of quality care options, including in-home care. When you own a policy, you own a solution. Your loved ones will have the time to be family instead of caregivers.
LTC Tax
Long-Term Care Insurance has never been more critical than it is today. The problem of longevity and declining health is increasing the number of people needing help with daily living activities or requiring supervision due to dementia. However, several states are considering taxing residents who do not own a qualified Long-Term Care Insurance policy. Washington State has implemented such a plan that goes into effect in 2023.
As of this writing, California, Michigan, Minnesota, and New York, are getting close to their LTC tax. The other states actively considering such a tax include:
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Alaska
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Colorado
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Hawaii
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Illinois
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Missouri
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North Carolina
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Oregon
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Utah
One question is whether the states will give their residents any advance notice to obtain Long-Term Care Insurance to avoid the tax. It generally takes six to eight weeks to apply and get approved for coverage. Many people in Washington ran out of time to obtain Long-Term Care Insurance to avoid the tax. Since the tax is on all your earned income (no cap), you pay more tax as you make more money.
While most experts suggest planning for the costs and burdens of aging as part of retirement planning, the tax in these states may force people, even younger ones, to obtain coverage. Otherwise, these individuals will pay a tax for the rest of their lives.
Best Long-Term Care Insurance Options for 2022
The good news is the federal government, and the states regulate Long-Term Care Insurance. Tax-Qualified Long-Term Care Insurance that meets federal guidelines under Section 7702(b) of U.S. code includes several consumer protections and uniform benefit triggers that are clear cut between insurance companies.
The cost of insurance varies dramatically between insurance companies. Premiums can vary over 100% for the same benefits. Long-Term Care Insurance is medically underwritten, so you must have reasonably good health to obtain coverage. However, the underwriting criteria also vary between companies.
There are more similarities between companies than differences; however, like anything else, some options are better than others. LTC NEWS reviewed the top companies that offer this coverage, both 'traditional' Long-Term Care Insurance and asset-based policies (hybrid) plans that combine life insurance or annuities with qualified Long-Term Care Insurance benefits.
2022's TOP Long-Term Care Insurance Options
#1. Mutual of Omaha
Mutual of Omaha is again the number one option for traditional Long-Term Care Insurance.
The company has been the industry leader for many years. Mutual of Omaha (a mutual insurance company) is rated A+ Superior by AM Best and has outstanding ratings with all the primary rating agencies for financial strength.
However, the company released a refreshed product which is more expensive than their previous products. If you were shopping several years ago and decided to wait, you will pay more today as all companies in the past few years have 'refreshed' their rates to adjust for the low-interest rate environment. While this did not impact policyholders, those buying policies today see higher rates than they have in the past.
Despite that, Mutual of Omaha is the best value in today's marketplace for Long-Term Care Insurance.
Mutual of Omaha has two very similar products: MutualCare Custom Solution and MutualCare Secure Solution. However, most Long-Term Care Insurance specialists recommend MutualCare Custom Solution.
MutualCare Custom Solution offers a wider variety of features and options which can easily be custom-designed to fit your budget and needs.
Perhaps the most important option is their inflation "buy-up" option. The policyholder can increase their inflation benefits in the future (through age 74) without evidence of insurability. Since most people purchasing LTC Insurance are in their 50s, this gives the policyholder the ability to increase their benefits when their health starts declining.
Younger applicants can choose a lower inflation benefit at a much lower cost, perhaps when they have more expenses (like paying for their kid's college), and increase the inflation rate later when those expenses are reduced.
MutualCare Secure Solution has fewer options and is less customizable than Custom Solution. We highly recommend only considering MutualCare Custom Solution. A Long-Term Care specialist who works with all the major companies will understand the differences.
Multiple inflation options, shared spousal/partner benefits, adjustable benefit levels for a nursing home compared to home care and assisted living, respite care, hospice benefits, care coordination, and additional money to pay for equipment and supplies if you are receiving care at home are all part of the policy. No question, the policy is comprehensive.
Many couples include shared spousal benefits that allow one spouse or partner to use the other's benefits if they exhaust them. However, when one spouse dies, the entire remaining unused benefit goes to the survivor even though the premium has disappeared.
Mutual of Omaha includes an alternate care benefit which can be very important if you are under age 65 when purchasing a policy. The alternate care benefit allows the insurance company to pay for care options not listed in the policy, that may not even exist today, as long as it benefits your care and is cost-effective.
There will be advances in technology and caregiving in the decades ahead. Mutual of Omaha will consider paying for those items even if they are not in the policy, making the policy a 'living breathing' document benefiting you and your family.
Pros
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Financially very strong mutual company that has been in business since 1909.
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Outstanding reputation
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Highly customizable
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Monthly benefits as opposed to daily benefits. The company looks at all the bills for the month instead of daily.
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Pool of money product - if the policyholder does not use the entire monthly benefit at the time of claim, the remaining money stays in the benefit account and grows with inflation (if selected)
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Available shared spousal benefits
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Multiple inflation options
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Good health and spousal discounts
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Waiver of premium when receiving benefits
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Very affordable for single/partnered men
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Partnership certified
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International benefits
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Shared spousal/partner benefits available
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Cash benefit included
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Alternate care benefit
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Hospice and respite care
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Bed reservation benefit
Cons
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Affordable but more expensive than in the past
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Unavailable if both your parents had been diagnosed with dementia/Alzheimer's (or parent and sibling)
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More expensive for single women
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Long underwriting process
#2. Thrivent Financial
Ranked number two for 2022 is Thrivent Financial. While not well known by some people, Thrivent is a non-profit fraternal organization, a Fortune 500 company, and has the highest AM Best Rating of A++ (Superior). It also has a COMDEX rating of 100 (the highest possible).
However, it is not a company available to everyone.
Thrivent was founded as a mutual benefit society for Lutherans, but today, Thrivent offers products to all Christians. Therefore, a policyholder must indicate they share Christian values seeking to live out their faith as a Christian or are married to a Christian. There is a question on the application asking this question.
The company's commitment to Christian values is either a strong positive for consumers or could be a hurdle for others. Unless you consider yourself a Christian or are married to a Christian, Thrivent would not be an option.
Thrivent has a comprehensive policy that offers a monthly benefit to pay for future care. The policyholder creates a benefit account with a benefit period creating an initial pool of money. If the policyholder does not use the maximum amount of available monthly benefit at the time of claim, the remaining money stays in the account and grows with inflation.
A benefit period does not mean you have benefits for only a certain period of time, but it would be the minimum length of time your benefits would last.
While the benefit period can be confusing, it works like most other companies by creating a benefit account or pool of money that can grow with inflation. Benefits not used are not lost and remain in your account.
The company offers shared spousal benefits and several inflation options, making customization easier. Thrivent's shared benefits work similarly to Mutual of Omaha, but unlike other companies that offer a third shared benefit pool.
The rider links two policies together. If one spouse exhausts their benefits, they can access the other spouse's benefits. However, 100% of the remaining unused benefits will go to the survivor when one spouse passes away, even though the premium has disappeared.
Single women, again, pay for more coverage compared to single men. Spousal discounts are also available. The policy also offers a cash rider giving the policyholder additional cash at claim time.
Their underwriting standards require longer stability periods following recovery compared to most companies. You might have to wait longer to be eligible to purchase coverage following some surgeries or health events compared to other companies.
Again, make sure your agent asks many health questions before considering Thrivent as an option. A Long-Term Care specialist who works with all the major companies will understand these differences.
If you like the idea of your premium disappearing once you are retired, Thrivent offers a way for you to pay off your policy in ten years. Their 10-pay option allows you to have a fully paid policy with no additional required premium after ten years.
Thrivent is partnership certified in most of the states that participate in the partnership program.
Pros
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Financially very strong
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Outstanding reputation
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Non-profit and pays dividends
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Multiple inflation options are available
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Monthly benefits as opposed to daily benefits. The company looks at all the bills for the month instead of daily.
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Pool of money product - if the policyholder does not use the entire monthly benefit at the time of claim, the remaining money stays in the benefit account and grows with inflation (if selected)
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Waiver of premium when receiving benefits
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Shared spousal/partner benefits available
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Cash rider available at extra charge
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Partnership certified
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Care coordination is available at the time of claim
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Limited payment option available
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Respite care benefit
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Ancillary benefits include equipment, home modification, and caregiver training
Cons
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Religious affiliation eliminates some people
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Much more expensive for single women
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Elimination periods requires at least one day of paid services in a calendar week to receive credit for seven calendar days
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Very limited international benefit
Another note - as a fraternal organization, Thrivent cannot participate in the state guaranty association in any state. The Guarantee Association ensures that you would still have guaranteed benefits. However, money would be available to pay claims if a financial crisis affects the insurance company and they cannot pay claims on your policy.
Thrivent is still required by law to maintain policy reserves equal to the present value of future benefits guaranteed in Thrivent contracts, less the current value of future premiums. Thrivent holds the necessary reserve and contingency funds to continue to provide guaranteed benefits even under very adverse conditions.
#3. National Guardian Life (NGL)
Number three on our top three list for best options for traditional Long-Term Care Insurance is National Guardian Life (NGL). NGL is a mutual insurance company founded in 1909 with nearly $5 billion in assets. The company has been in the long-term care marketplace since 2016, although experts who designed the product have decades of experience.
NGL is a financially strong company with an AM Best rating of A.
What makes NGL unique in 2022's top three is their shared "third pool" partner benefit. The company offers a couple one policy for two people. Each person has an individual benefits account that grows with inflation. However, when the shared option is selected, they get an additional third account that also grows with inflation. If either person exhausts their own benefits, they can dip into the third account.
NGL's shared benefit offers policyholders outstanding coverage for the money, depending on their age and health.
NGL is a very conservative underwriter. Be sure the insurance agent/advisor or Long-Term Care Insurance specialist asks you detailed questions about your health and thoroughly understands the underwriting standards.
Generally, a Long-Term Care specialist who works with all the major companies will understand the underwriting criteria which every company.
Another concern is NGLs' use of a "daily" benefit instead of a "monthly benefit" many companies offer. With a daily benefit, the company looks at bills each day instead of all the bills at the end of the month. When you have in-home care, you might have multiple providers on one day, causing that day's cost to be higher. You could see more out-of-pocket expenses than you would with a monthly benefit with a daily benefit.
NGL is partnership certified in most states that participate in the partnership program.
Their 'third pool shared spousal/partner benefit' is perhaps the primary reason to consider NGL; however, their lack of customization and overall pricing can make NGL more expensive.
There is no spousal discount if a married or partnered individual applies without their partner. NGL is much more expensive for single women.
NGL has two limited pay options. You can pay the premium in one or ten years and have a fully paid policy with no additional premium ever required. If you like the idea of not paying the premium every year, these limited pay options would be a good choice.
The policy lacks an alternative benefit provision that both Mutual of Omaha and Thrivent Financial include. Those who purchase coverage in their 40s or 50s may be concerned that changes in technology and caregiving options may limit their policy in the decades to come. However, there is nothing to stop the company from adding new benefits in the future (without charge), although they cannot take away benefits from your policy.
Pros
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Limited payment options available
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Third shared benefit account for couples/partners
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Waiver of premium at the time of claim waives 100% of a couple's premium since it is one policy for two people
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Partnership certified
Cons
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Very conservative underwriting
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Only offers a "daily benefit" - no monthly benefit available
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No alternative benefit option - future changes in caregiving and technology would not be covered
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Limited inflation options
NEUTRAL RATING
Several companies offer qualified Long-Term Care Insurance products that meet federal guidelines under Section 7702(b). No individual agent, agency, or advisor can offer special deals. Insurance companies must file their products and pricing with each state's insurance department.
While better value exists with the top three, these companies provide compressive policies that address the costs and burdens of long-term health care. These companies have our neutral rating.
New York Life and Northwestern Mutual are the two most expensive Long-Term Care Insurance products available.
New York Life
New York Life is an outstanding and financially strong insurance company. Despite being financially strong, the premiums are very high. They also affiliate with AARP with a branded Long-Term Care policy. New York Life has paid AARP for this endorsement.
New York Life also offers a product named "My Care," which comes with cash deductibles and an 80/20 co-insurance structure. Most specialists do not consider " My Care " a good option because of the high-cost sharing.
Note that New York Life agents often talk about dividends. Some agents show illustrations that show the premiums disappearing when the insured is in their 80s because of dividends. Most actuaries say the likelihood of this happening is extremely low.
The bottom line: Don't depend on any future dividends to ever pay back the cost differences between New York Life and other companies.
In addition, many New York Life agents will offer a policy with no inflation benefits or 'purchase options' that increase the premium regularly. Most people will want to avoid that type of policy design.
The company also offers an inflation benefit based on the CPI (Consumer Price Index), so there are no 'guaranteed' benefit increases; they are variable. The premium cost is high, and it is not recommended.
Consumers will find much better value elsewhere.
Northwestern Mutual
Like New York Life, Northwestern Mutual is an outstanding and financially strong insurance company. However, premiums are very high, and the product is not at all competitive. Like New York Life, Northwestern Mutual agents will offer a policy with no inflation benefits or 'purchase options' that increase the premium regularly. Most people will want to avoid that type of policy design.
Consumers will find much better value elsewhere.
LifeSecure (Blue Cross - Blue Shield of Michigan)
At one time, LifeSecure was one of the leaders in individual Long-Term Care Insurance. However, several years ago, they stopped offering individual products and concentrated on the employee benefits market.
The current product is basic and not very competitive against other products; however, it could be an option if your employer plan includes relaxed underwriting — therefore, our neutral rating.
NOT RECOMMENDED
There are several companies not recommended. These companies offer products that meet federal guidelines; however, they are not recommended for various reasons.
These companies include:
Banker's Life
Bankers Life is the primary subsidiary of CNO Financial Group, Inc. (formerly known as Conseco, Inc until 2010). They have improved their AM Best rating to A- but the company and its parent have had financial problems in the past. Bankers Life holds a BBB+ from Fitch, Moody's ranked them at Baa1, and Standard & Poor's remains at BBB+.
In addition to the past financial issues, the company has gained a reputation for not paying claims. A report by CBS News highlighted some of Bankers Life customers' problems when processing claims.
There are also numerous poor online reviews; however, most company reviews are negative by nature and should not be the only thing to look at when reviewing an insurance company.
There have also been media reports of high-pressure sales tactics used by Banker's Life agents. All their products are sold by "captive agents" who only offer their products.
The product itself is in line with most other policies. It has many extra options you can choose from at an additional cost. Banker's Life still uses a daily benefit instead of a monthly benefit, but overall has numerous features and options. However, considering everything, Banker's Life is NOT RECOMMENDED.
Federal Long-Term Care Insurance Employee Plan
John Hancock administers the LTCFEDS plan available to federal government employees and spouses. The pricing for this product is very competitive; however, there are numerous pitfalls.
The biggest downfall is that the policy is not partnership certified in any state. Also, the federal government does not have to abide by any state's insurance rules, including rate stability.
The benefit trigger on the policy includes the wording, "and we agree." You do not see this language in leading competitive products, which could impact the ease of making a claim in the future.
Unlike most other plans, there are no premium classes based on gender since it is a group employee plan. Since women live longer and thrive in a care environment longer, the federal plan may have additional pressure to maintain premiums into the future.
The Fed plan also uses daily benefits instead of monthly benefits and includes several inflation options. However, since no agent is involved, many federal employees select the future purchase option (FPO).
With the FPO, the premium will go up every time you wish to adjust benefits to keep up with the higher cost of care. The premiums would then keep going up, or your benefits would freeze in time despite the increasing cost of care services.
John Hancock, however, has a good reputation as the administrator for the program. Federal employees should look at this plan, but federal employees and their families should consider other options. It may be tempting to purchase this policy; however, it remains - NOT RECOMMENDED.
Knights of Columbus
The Knights of Columbus are similar to Thrivent, but the company limits its products' availability to Roman Catholics. Very financially strong, the Knights have a good reputation. However, Long-Term Care Insurance is not a primary product.
The biggest downfall is the policy includes "usual and customary" language. At the time of claim, no matter what benefit you selected, and the provider's actual cost of care being billed to you, the insurance company will determine if the charge is "usual and customary."
For Long-Term Care Insurance, this is an unusual provision that limits the amount of benefits available at the time of claim. For this reason, this policy is NOT RECOMMENDED.
Asset-Based "Hybrid" Long-Term Care Insurance
Asset-based "hybrid" policies combine a life insurance policy or annuity with Long-Term Care Insurance benefits. Either way, you will get the death benefit or the long-term care benefit. They are typically paid with one single premium and are expensive; however, you get the death benefit once you die if you never received long-term care benefits.
The only Hybrid policies recommended are products are those that are federally tax-qualified Long-Term Care Insurance policies as defined in IRS Code Section 7702(b). These federal regulations provide customer protection and standard benefit triggers that give the policyholder and their family additional peace of mind.
The primary companies for these products are:
Brighthouse Financial, Nationwide, and Securian offer cash benefits. Hard to beat a cash benefit. The company will pay you the full available benefit in cash. If you want complete flexibility at the claim time, one of these cash policies will be the solution.
One America offers a hybrid policy for two people with a second-to-die death benefit and an annuity/long-term care product that offers reduced underwriting.
Brighthouse Financial also offers a plan but is less competitive (although it is a cash benefit). However, it should not be ignored as their underwriting is a bit broader than some other companies and offers full international benefits.
All of these are highly rated and financially strong companies. If you decide an asset plan is best for you and your family, limit your research to the above companies.
Trustmark also offers a life insurance option with a qualified long-term care benefit; however, it is only available through an employer. It is a very small benefit and pays out the death benefit in advance over a period of months. It is not considered a viable option for long-term health care planning.
Trustmark is only available through an employer. It does have reduced underwriting and is fairly inexpensive. If you have preexisting health issues, it might be something to consider.
Limited Duration/Short-Term Care Options
These products are not long-term care policies; they are cash indemnity plans that can offset the cost of long-term health care at home or in a facility.
These products can provide some benefits that can be beneficial when other options are not available (due to age or pre-existing health issues) - or for a person adding on to an existing Long-Term Care Insurance policy.
NOTE: These products are not available in every state. You can see if your state has one of these products.
Recommended
Aetna/Continental Life
Aetna has two available products.
Recovery Care is the most comprehensive. It is a cash indemnity policy. Once you qualify for benefits, the policyholder gets the full eligible benefit in cash, no matter the size of the actual bill. You can use any provider you wish, including family, with a cash benefit.
It will pay up to 360 days for any long-term care facility (nursing home, memory care, rehab, or assisted living facility). In most states, Aetna includes a restoration of benefits that provides an additional 360 days if you recover and go 180 days without requiring care. The maximum benefit choice is $300 a day.
Aetna will pay for up to 52 weeks of in-home care. The maximum benefit choice is $1200 a week (Texas allows up to $3000 a week). It also includes a restoration of benefits in most states.
There is also a hospital indemnity that offers up to $300 a day every day you are in the hospital. This benefit has nothing to do with your health insurance or Medicare. It pays cash directly to you for each day in the hospital.
The idea here is as you get older, you typically go to the hospital more often. After leaving the hospital, you often go to care either in-home or in a facility. You do not need to be receiving long-term care services to qualify for this cash benefit, as an overnight hospital stay triggers the benefit.
Underwriting is much broader than Long-Term Care Insurance.
Aetna also offers Home Care Plus. This product eliminates the facility portion of the product above. Some people who are ineligible for Recovery Care may qualify for this product.
These products are not available in every state.
Standard Life is similar to Aetna's Recovery Care and uses the same name. The underwriting is a bit more conservative. Like Aetna, the product is not available in every state.
Guaranteed Trust Life (GTL) also has plans similar to Aetna and Standard Life. GTL has a home care only plan that may offer limited coverage to people who cannot obtain coverage from other companies. The product is not available in every state.
Seek Professional Advice
It is imperative that you seek the help of an experienced Long-Term Care Insurance specialist who will help you navigate the many available options. Most insurance agents and financial advisors lack knowledge of these products, underwriting, and pricing.
You should work with a specialist representing the major companies, not just one or two.
Plus, non-specialists are often not "partnership certified" and do not complete the required ongoing professional training in all of these products.
Be sure your "specialist" is actually a specialist. A Long-Term Care Insurance specialist should represent the major companies that offer these products. They should have experience not in years - but in the total number of clients they have helped with long-term care planning.
Some specialists have thousands of clients; your specialist should have at least a few hundred people they have helped with long-term health care planning.
The specialist should also have complete knowledge of the partnership program, underwriting, policy design, and claims.
Find a trusted and qualified specialist.
Best to Plan Early – Ideally in Your 40s or 50s
Most people who purchase Long-Term Care Insurance are in their 50s. It is always best to start planning for long-term health care before you retire, ideally in your 40s or 50s, when premiums are at the lowest, and your health is better.
The fact is you will experience changes in your health, body, and mind in the decades ahead. Prepare your family and finances with affordable Long-Term Care Insurance. You will not only safeguard income and assets, but you will reduce the stress and burdens otherwise placed on your family.
Long-term health care costs are increasing rapidly nationwide, placing more financial pressure on American families. The LTC NEWS Cost of Care Calculator will show you current and future cost of care services and other crucial state-specific information on planning solutions, care options, tax incentives, and more.
But remember, long-term care is both a cash flow problem and a family problem. When you own a Long-Term Care Insurance policy, you own a solution that not only safeguards income and assets but gives your loved ones the time to be family instead of caregivers.