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Neither long-term care insurance nor self-funding is best for everyone. Insurance can shift some care costs to an insurer, but only within a policy’s limits and in exchange for premiums that may change. Self-funding avoids those premiums but leaves care bills to be paid from income and assets. The right choice depends on local care costs, what a policy actually covers, your health and ability to qualify, the household’s finances, and which assets you want to protect. Many households use a combination of resources rather than relying on one source alone.
What long-term care includes—and why the distinction matters
Long-term care is not another name for a nursing-home stay. It can mean help with daily activities or personal care at home, in a community setting, in assisted living, or in a nursing home. Some services may be skilled; much long-term care is custodial or personal care rather than ongoing medical treatment. The setting and kind of help you expect therefore matter when comparing possible funding sources.
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The National Association of Insurance Commissioners (NAIC) reports in its 2022 consumer guide that about 70% of people who reach age 65 are expected to need some form of long-term care at least once in their lifetime. It also reports that about 35% are expected to enter a nursing home at least once; among people who do, the average stay is reported as one year. These are population-level estimates, not predictions for an individual or a promise about how long any one person will need care.
A separate statistic on the NAIC’s consumer page, attributed there to the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation (ASPE), says that 70% of adults who survive to age 65 develop severe long-term services and supports needs before they die, while 48% receive some paid care over their lifetime. Those figures use different measures from the NAIC guide’s estimates; they should not be treated as interchangeable or combined into a personal forecast.
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What each option means in practice
Long-term care insurance
You pay premiums for a contract that may reimburse or pay for covered care when its conditions are met. The contract defines the benefit amount, benefit duration or maximum pool, qualifying rules, covered services and settings, exclusions, and any inflation feature. It may pay only part of a bill, may not cover a preferred service or setting, and may run out before care ends. Premiums can also change under applicable policy and state rules, so the initial premium is not the only amount to evaluate.
Insurance transfers only the risks described in the policy. It is not a guarantee that every future long-term-care expense will be paid. Read the contract and compare its actual terms with the care you might use, rather than judging a policy by its name or headline benefit.
Self-funding
Self-funding means planning to pay care costs from household income and assets when they arise. Resources can include savings, investments, and other assets such as a home, as the NAIC identifies in its consumer materials. It does not require insurance underwriting, but the household bears the risk that care lasts longer or costs more than anticipated. Spending on care can reduce money available for a spouse, other goals, or inheritance.
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A combination
Some households use insurance for a defined portion of the risk and retain savings to cover premiums, policy gaps, or care after benefits end. Personal resources may also be combined with Medicaid for people who qualify under applicable rules. A combination can distribute the risk, but it does not make the expenses disappear: each source has its own limits, conditions, and effect on household finances.
How insurance and self-funding compare
| Decision factor | Insurance | Self-funding | What to examine |
|---|---|---|---|
| Cash flow | Premiums are paid over time and may change under the policy and state rules. | Care costs are paid from income and assets when needed. | Can the household sustain premiums through retirement? If paying for care directly, what reserves remain? |
| Amount and duration | Benefits are limited by the contract’s benefit amount and period or pool. | There is no insurance benefit pool, but bills can deplete available resources. | Compare policy limits with current local costs and more than one possible duration of care. |
| Settings and services | Covered care depends on policy terms; settings, services, and exclusions vary. | Available resources can be used for selected services, subject to affordability and availability. | Check that the preferred setting and services qualify under the contract. |
| Rising costs | An optional inflation feature may increase benefits and premiums. | The household carries the risk that care costs rise faster than its assets. | Use local cost assumptions and compare them with any inflation feature; do not treat old national averages as current quotes. |
| Health and access | Individual policies commonly require underwriting; health can affect access or cost. | No insurance underwriting is needed, though the household still needs to be able to pay and obtain care. | Do not assume acceptance. Investigate options while coverage may still be available. |
| Assets and family goals | Benefits may help preserve assets, but premiums and uncovered bills still affect wealth. | Money not spent on premiums remains available for other uses until care costs arise. | Identify assets intended for care, a spouse, or inheritance, and account for state Medicaid and estate-recovery rules. |
Start with your care preferences and household plan
Before comparing policies with a savings balance, decide what kind of care you would want and who could help make decisions if you could not. A plan should account for more than a nursing home: consider whether you would prefer care at home, assisted living, a community setting, or a facility, and who might provide or coordinate help. The NAIC also encourages consumers to consider health, finances, preferred living arrangements, trusted decision-makers, and end-of-life wishes.
Discuss the plan with people who may be involved. A spouse or family member may have a different view of what care is feasible, which assets should remain available, or how much unpaid help they can realistically provide. Do not count on informal care as if it were guaranteed: availability and affordability of paid services also need to be considered.
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Estimate local care costs before deciding
Use current information for your state and the settings you are considering. A national average cannot tell you what care will cost in your community, what services will be available, or how much a particular policy will pay. The NAIC’s consumer page includes these U.S. averages for 2017:
| Care measure | NAIC figure | Date and qualification |
|---|---|---|
| Nursing-home care | $82,125 per year | U.S. average reported for 2017; historical, not a current price. |
| Assisted-living care | $43,435 per year | U.S. average reported for 2017; historical, not a current price. |
| Home-health aide | Approximately $21 per hour | U.S. figure reported for 2017; historical, not a current price. |
These figures can illustrate why setting and duration matter, but they are too old to use as a present-day budget. Obtain current local estimates for each setting you might choose. Then consider how the bill could change if care is needed for a shorter or longer period, or if the services required differ from what you first expected.
Compare actual policy terms, not just premiums
Request multiple quotes from insurers licensed in your state and review the contracts. A quote is not a complete comparison unless you know what benefit it buys and under what conditions it is available. The NAIC’s 2022 A Shopper’s Guide to Long-Term Care Insurance says: “Not everyone should buy a long-term care insurance policy nor rely solely on long-term care insurance.” The practical implication is to assess both the contract and the part of the risk it leaves with you.
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- Benefit amount: Identify the daily or monthly benefit and compare it with local costs for the setting and services you prefer.
- Benefit duration or pool: Find the maximum period or total benefits available. Consider whether coverage could end while care is still needed.
- Qualifying and waiting provisions: Read the contract’s eligibility rules and any waiting provisions. Do not assume a particular care need automatically triggers payment.
- Covered settings and services: Verify coverage for home care, assisted living, facility care, or any other service you expect to use. Check how the policy treats informal care and what it excludes.
- Inflation protection: Understand how an optional feature changes benefits over time and how it affects premiums. Compare the resulting benefit with plausible local cost increases.
- Premium affordability and rate history: Ask about the policy’s rate-increase history and applicable rules. Model premiums as an ongoing expense rather than assuming the initial quote will remain unchanged.
- Underwriting and availability: Confirm whether you can qualify; do not build a plan around coverage before an insurer has evaluated the application.
Two policies with similar initial premiums can offer different protection because of differences in benefit limits, covered care, inflation features, or exclusions. Conversely, a policy with a larger benefit may require premiums that do not fit the household’s long-term budget. The comparison is between full contract terms and the household’s ability to carry both premiums and remaining costs.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Model what the household would pay under each path
A useful comparison is a set of scenarios, not a single break-even age or a guess about one future care event. The available evidence does not establish a universal age, net-worth threshold, or break-even rule for choosing insurance. Build a simple household model using current local costs, actual policy quotes, and more than one duration and cost assumption.
- Set the time horizon. Look at the years before care might be needed as well as the period during which care could continue. Include premiums for the years a policy is held, rather than comparing one year of premium with one year of care.
- Run several care scenarios. Estimate costs for the preferred setting and for plausible alternatives, using current local figures. Include different durations so one short-care assumption does not determine the decision.
- Calculate the insurance path. Include premiums, covered benefits, the cost of any care the policy does not cover, and any expenses that fall outside its benefit period or pool. If premiums change, include that possibility rather than projecting only the initial amount.
- Calculate the self-funding path. Estimate care spending from income and assets and identify what would remain for a spouse and other goals. Consider how a longer period of care or rising costs could affect that reserve.
- Test the household trade-offs. Compare both paths with retirement income, essential bills, emergency reserves, and the assets you want to protect. A plan that requires unaffordable premiums is not made sound by a large theoretical benefit.
- Review assumptions with qualified help if needed. A state-licensed insurance professional can explain policy terms; a fiduciary financial planner can help assess how care spending fits broader household goals. Any professional should make the costs, compensation, and scope of advice clear.
This is a planning framework, not an individualized break-even calculation. The result depends on assumptions about care, premiums, future costs, household resources, and the policy. Change the assumptions and the apparent advantage may change too.
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Account for Medicare and Medicaid correctly
Medicare is not a general long-term-care funding plan
Medicare generally does not pay for most custodial long-term care, and Medigap generally does not fill that gap. Medicare may cover limited skilled care under specific conditions, but that is different from ongoing help with daily activities or other custodial care. Do not treat Medicare as the planned source for years of long-term support.
Medicaid may be part of a plan, but eligibility is state-specific
Some people may qualify for Medicaid, subject to federal and state rules and their circumstances. Eligibility, asset rules, partnership programs, and estate recovery depend on state law and household facts. Do not assume Medicaid will pay from the beginning, that a particular asset is treated the same way in every state, or that every nursing home accepts Medicaid. If later Medicaid eligibility is part of your plan, check the rules in your state and whether the facility you are considering accepts Medicaid.
Which approach may fit your circumstances?
These are decision patterns, not eligibility rules or personalized recommendations. The same household may fit more than one description, and the outcome depends on the contract, finances, health, and care preferences.
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- Insurance may merit a closer look if you can qualify, can sustain premiums without jeopardizing essential expenses, and value transferring some defined care-cost risk or protecting some assets. The policy still needs to cover care you would actually use at a meaningful level.
- Self-funding may be more workable if you have resources set aside for care, accept the possibility that costs could draw down those resources, and prefer not to carry premiums. Check how a prolonged or more expensive care need would affect a spouse and other financial goals.
- A mixed approach may suit a household that wants to limit a portion of its exposure but can also reserve money for premiums, uncovered expenses, or care after benefits end. Its usefulness depends on the policy limits and the resources available to fill the gaps.
- Neither plan should endanger essential finances. The NAIC advises consumers to consider whether they can afford premiums. Do not buy coverage at the expense of essential bills, and do not call self-funding a plan unless the household has identified how it would pay the bills.
A practical decision checklist
- Write down preferred care settings, likely sources of help, trusted decision-makers, and any wishes that would guide care.
- Gather current local cost estimates for those settings rather than relying on national historical averages.
- List income, savings, investments, other assets, essential expenses, and the resources that should remain available for a spouse or other goals.
- If considering insurance, obtain multiple state-licensed quotes and compare benefit amount, duration or pool, eligibility and waiting provisions, covered services and settings, exclusions, inflation protection, premiums, and rate-increase history.
- Read the policy contract and check that its terms match the care you expect to use; do not rely on a quote summary alone.
- Compare insurance and self-funding across multiple care-cost and duration scenarios, including ongoing premiums and costs the policy would not pay.
- Check state Medicaid rules and facility participation if later Medicaid eligibility is part of the plan.
- Choose insurance, self-funding, or a combination based on what the household can afford and the amount of risk it is prepared to retain.
This is general U.S. consumer information, not individualized insurance, tax, legal, or financial advice. Policy availability, premiums, underwriting, care costs, and rate histories can change. Medicaid rules vary by state, and a decision should be checked against current local facts and the household’s circumstances.
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