Do I need long term care insurance? It depends on your savings, your health, your family and how you would want to pay for care if you needed it. There is no single right answer, and no one can tell you from a brochure.
The direct answer: it makes the most sense for people who have enough assets to worry about protecting, but not so much that they could comfortably pay for years of care themselves. I’m Mike McClernon. I do not sell insurance, I place families in assisted living, memory care and independent living, and I see every year how care gets paid for. This is general guidance, so please confirm anything specific with a licensed advisor or an elder law attorney.
Why do people ask whether they need it?
They ask because Medicare does not pay for assisted living, memory care or independent living rent, and most people are surprised by that. Long term care means help with daily life over a long period, and it can last for years.
Insurance is one way to prepare. Others include savings, home equity, retirement income, veterans benefits and, for people with limited funds, Medicaid. I walk through the major options in whether Medicare covers long term care, which is a good starting point if you are not sure what is already covered.
Families often start asking when a parent has a health scare, or when they see a neighbor go through a hard move. If that is your situation, you may be looking for what to do now, rather than whether to buy a policy for yourself.
Who tends to benefit from a policy?
People in the middle tend to benefit most. If you have assets you want to protect for a spouse or children, but a long stay in care would put real strain on them, insurance can share the risk.
- You are in your 50s or early 60s and still healthy enough to qualify
- You have a spouse or partner you want to protect from a drained savings account
- You want choices about where care happens and do not want to rely on Medicaid
- You have a family history of dementia or other conditions that often need long term care, and you want to talk to a doctor about your own risk
- You can afford premiums for decades without strain
Age matters because health matters. Insurers look at health at the time you apply, and waiting can close the door. I wrote more about this in whether long term care insurance is worth it for Long Island families.
Who may be fine without one?
Some people can reasonably skip it. If your assets are small and Medicaid would be your backup anyway, premiums may not buy much. If your wealth is large enough to pay for years of care out of pocket, you can self insure.
There is also the person who simply cannot get coverage. Some health conditions rule people out, or push premiums beyond reach. If that is you, other planning tools still exist, including veterans benefits, family agreements and a conversation with an elder law attorney about Medicaid planning rules.
The point is to choose on purpose. Many families do not decide at all, and by default, they end up paying out of savings.
What should a policy cover?
Read the policy terms before the price. Two policies with the same premium can pay very different amounts. Use this table as a conversation guide with your agent.
| Policy term | What it means | Ask |
|---|---|---|
| Daily or monthly benefit | The most the policy pays per day or month | How does it compare with local care costs? |
| Benefit period | How long payments last | Is it limited by time or by a total pool of money? |
| Elimination period | The wait before payments begin | Do I pay during that wait? |
| Inflation protection | Whether the benefit grows over time | Is the increase simple or compounded? |
| Benefit triggers | What proves you need care | Does cognitive impairment qualify? |
| Covered settings | Where care can happen | Does it include assisted living and memory care? |
Ask whether memory care is covered by name. It is the setting families most often need, and the one where premiums matter most. I describe what it includes in what memory care actually includes.
What can stop you from getting approved?
Your health history can. Insurers review medical records, medicines and sometimes a phone interview, and certain conditions can lead to a denial or a higher price. Existing diagnoses such as memory loss are a common reason for a decline.
I explain the typical issues in what disqualifies you from long term care insurance. The takeaway is that the best time to apply is before a health problem appears, not after.
If you already have a policy from years ago, dig it out. Many families learn they have coverage only after a crisis, when it could have helped plan earlier.
How does a policy work when someone moves in?
Usually you file a claim, show that you meet the policy’s trigger, wait out the elimination period and then submit bills or proof of care. The insurer pays according to the policy terms, either to you or to the community.
Communities in the Long Island area see this often, and their business offices can help with the paperwork. I go through the claims steps in how long term care insurance works when you move into assisted living, and I have a shorter piece on paying with a long term care policy.
One more tip: some people look at life insurance policies that include a long term care feature. I cover that in using life insurance to cover senior living costs. Any plan needs review by a licensed professional.
What does the policy still leave out?
Even a good policy rarely covers every dollar. Most pay up to a limit, and the rest comes from income, savings or family. Communities charge a base rent plus care, and the total rises as needs rise.
To see what a month of memory care might include, read what the average monthly cost of memory care covers. I do not quote dollar amounts here because they vary by community, and any figure would be out of date soon.
Planning is easier with a clear picture, and a senior living advisor can help you see it. I plan 18 to 24 months ahead with families so a rising level of care does not surprise the budget.
Talk it through with Mike in Glen Cove
I cannot sell you a policy or tell you which to buy, but I can show you what care looks like on Long Island and how families pay for it. My help is free. I place people in assisted living, memory care and independent living across Nassau, Suffolk and Queens. Learn how I work on my free senior living advisor information, or browse common questions in the senior living FAQs.
My office is at 42 Prospect Ave, Glen Cove, NY 11542. Use the contact form to set up a free first conversation.
Questions readers ask
What does long term care insurance cover?
It usually pays toward care over a long period once you qualify, such as help with daily tasks. Which settings are covered depends on the policy, so read the details and ask your agent.
Where do you buy long term care insurance?
Through a licensed insurance agent or broker, ideally one who can compare several companies. Make sure the person is licensed in New York.
Is 70 too late to buy long term care insurance?
Coverage gets harder to qualify for and more costly with age and health problems. A licensed advisor can tell you what is realistic for you.
What if I buy a policy and never need care?
Then the premiums are the price of protection, similar to home insurance. Some hybrid products return value to heirs, so ask about those options.
Can a financial advisor or attorney help me decide?
Yes. A licensed advisor can compare costs and an elder law attorney can address legal and Medicaid planning. Get advice before you commit.
Read next
Watch: Mike explains
How Life Insurance Can Help Pay for Assisted Living
Most families don't know this: a life insurance policy your parent has been paying on for decades can become a source of funds for...
Next step: see Mike’s guide to senior housing on Long Island, or browse the Long Island community profiles.
