The Best Long-Term Care Insurance

The 30-Second Review

When it comes to the best long-term care insurance, premium prices are always going to matter. But because those vary so much from person to person, we turned our sights to flexibility and financial strength to find which providers deliver the most robust coverage, and which you can be sure will be able to pay out their claims.

Our Top Pick

Excellent financial strength and all the waivers and riders we wanted to see. Plus, Mutual of Omaha has a few standout features (like counting the Elimination Period in calendar days) that just come standard.

Two Others to Consider

Shopping around to find the best price for the coverage you want is key. Transamerica and MassMutual are both excellent options that checked all our core requirements. Their policies just aren't quite as generous as Mutual of Omaha.

Long-term care insurance has been in the news. Premiums are (often way) up, and a few big-name providers are abandoning their coverage altogether. But LTC insurance doesn’t have to be an all-or-nothing proposition. Using insurance for even a portion of long-term care costs can make a big difference in retirement.

Our Top Pick

Mutual of Omaha Robust coverage and flexible policies, plus standout provisions that come standard.

That’s a big reason why we prioritized flexibility in choosing the best long-term care insurance companies. Our three top picks, Mutual of Omaha, Transamerica, and MassMutual, give customers the most choice when it comes to designing a policy, from the total amount of benefits to when and how they’re paid out. Mutual of Omaha stands out even more by counting its Elimination Period in calendar days instead of service days, which means policyholders can get access to their benefits faster.

That said, there’s no guarantee any of our top three will have the best-priced plans for you. The American Association for Long-Term Care Insurance found that 2016 rates for identical coverage varied by as much as 94 percent from one insurer to the next. Our advice: Shop around to find the coverage you want at a price you like. Our top picks are a great place to start.

Our Picks for the Best Long-Term Care Insurance

Our Top Pick

Mutual of Omaha The only one of our top picks with an Elimination Period by calendar days.

Mutual of Omaha earned our top recommendation for two reasons. It has unmatched flexibility in its policy design options, and a bonus feature that all our experts agreed is important: counting the Elimination Period in calendar days instead of service days. Among our finalists, only Mutual of Omaha offered this provision — and what’s more, it’s standard with the company.

A long-term care policy’s Elimination Period is the length of time you have to wait to receive benefits after your claim is opened. The longer the elimination period, the cheaper the policy, since it means you’ll be paying out-of-pocket longer before benefits kick in. The most common length is 90 days.

Most LTC policies count off the elimination period in terms of “service days,” requiring you to prove you received a service on a given day for it to count toward the total. “Calendar days,” on the other hand, mean if you have a 90-day elimination period, your benefits will begin exactly 90 calendar days after your claim is approved, whether or not you needed (and paid for) care each day. This not only takes away the hassle of submitting receipts, but also can save you money and effectively shorten the waiting period.

Beyond that, Mutual of Omaha offers benefit periods of two to five years — as well as the alternative “pool of money” model (up to $500,000), giving policyholders more choice in their policy design than any of our other finalists did.

A few other standard features also impressed us. The first is that independent home caregivers are covered, meaning they don’t need to be from an agency whose rates are likely more expensive. Home care services (such as health aide visits) are also not subject to the elimination period at all — they’re covered as soon as you need them. And Mutual of Omaha’s “cash alternative” payout can also be up to 40 percent of your policy’s maximum monthly benefit, which is 10 percent higher than our other finalists’. That means if your care costs are low in a given month, you can opt for a check equal to 40 percent of your policy’s monthly maximum in lieu of other benefits. You can spend that cash on anything, not just covered services — another nice measure of flexibility.

Honorable Mention

Transamerica A solid option, but Transamerica's terms aren't quite as generous as Mutual of Omaha.

Transamerica is another solid option for long-term care insurance, even if its standard features are slightly less generous than Mutual of Omaha’s. Its monthly cash alternative caps at 30 percent of the policy’s maximum monthly value (as opposed to 40 percent with Mutual of Omaha). And for in-home care, it requires that services come from an agency, which will likely charge more than an independent caregiver.

But we appreciate that Transamerica uses the more flexible “pool of money” model to define its policies’ benefits, and offers total benefit amounts as small as $18,250 — which means it’s more affordable for more people. Like Mutual of Omaha, Transamerica also includes a zero-day waiting period for home care, reimbursing those costs as soon as you first have a need for them.

Honorable Mention

MassMutual The best financial strength ratings our top picks, but MassMutual's policy offerings fall short by comparison.

MassMutual had the best financial strength ratings of all our finalists, but it fell short of both Mutual of Omaha and Transamerica in terms of useful policy options. The zero-day waiting period for home care (standard with our other top picks) is an optional extra with MassMutual, and there’s also no “cash alternative” benefit, meaning you have to submit receipts for absolutely everything.

The limitations go on: Benefit periods must be in years (no pool option) and the Shared Care rider is only available with the shorter plans (two- and three-year benefit periods). On the plus side, MassMutual offers the only six-year benefit period of our top three insurers, and covers in-home services from independent caregivers.

Sounds great, but how much is long-term care insurance going to cost?

The short answer: It depends. The factors that impact premiums vary way too much from person to person for us to recommend a provider based on price. Still, knowing which elements carry weight can help inform your policy search. For LTC insurance, premiums depend most on five things:

  • Your health and age when you buy the policy
  • The policy’s benefit period, either in years or total dollars
  • The maximum daily or monthly benefit
  • The elimination period
  • Optional riders, such as inflation protection

Inflation protection in particular can mean a huge difference in premiums — sometimes more than doubling them — but it’s wise to at least consider it.

"If they can afford it, I always recommend an inflation protection rider of 3 percent to my long-term care insurance clients."

Mickey Batsell Board Member at National Insurance Marketing Executives

After all, buying insurance is about removing financial risk from your life, and inflation is a legitimate risk to your policy’s future value. Think of it this way: At 3 percent annual inflation, the care you can get today for $200,000 will cost $268,783 in 10 years, and $361,222 in 20 years. That’s why the American Association for Long-Term Care Insurance recommends adding a 3 percent inflation rider — even though its 2016 price index found that it raised average policy premiums by the following amounts:

Without 3% Inflation Rider

With 3% Inflation Rider

Single Male, Age 55

$1,015
$2,035

Single Female, Age 55

$1,490
$2,580

Married Couple, Both Age 60

$2,010
$3,560

Long-term care costs also vary significantly from state to state, based on things like the availability of caregivers and nursing home beds), so it helps to plan for the region where you expect to retire.

Home Health Aide Costs for Long-Term Care Insurance

You can view costs of care in your state by visiting LongTermCare.gov and choosing different types of costs from the dropdown menu. Image credit: LongTermCare.gov.

Did You Know?

It pays to start planning early.

While nobody likes to consider the prospect of needing long-term care, addressing it sooner rather than later can make a huge difference to both your peace of mind and your bank account. The older you get, the more you’ll pay in premiums (and the more likely it is that you’ll develop a condition that makes getting covered more difficult).

“Your early 50s are an ideal time to investigate your options for long-term care.”

Premiums can still increase from year to year, but it’s much less likely now than before.

Premiums for traditional LTC policies surged in recent years as companies began to learn the true cost of claims, which they grossly underestimated when first selling policies in the 1980s and ’90s. Several companies – including big names like John Hancock and MetLife – ditched LTC insurance entirely as a result. In addition, some policyholders were also hit with unexpected premium hikes, a maddening twist particularly for older folks who had to pay more, reduce their benefits, or drop their long-held policies.

However, new research by the Society of Actuaries says the threat has largely passed: With more data to guide pricing, policies sold in 2014 have just a 10 percent chance of needing future rate increases, compared with 40 percent for those sold in 2000. It’s also helpful to know that premiums can never go up due to a decline in your personal health — only for an entire group of insured people because of higher-than-expected claims, and only after a state insurance department approves the increase.

LTC insurance covers more than just nursing home care.

When you consider the phrase “long-term care,” your first thought might be of a nursing home or an assisted living facility. But there are plenty of scenarios in which you’d need long-term care in your home, such as following a temporary injury or a stroke. These periods can still be expensive, which is why standard LTC insurance also covers visiting nurses, home health aides (who assist in bathing, dressing, and preparing meals), visitor programs, chore services, adult day care, and home-delivered meals.

Medicare will barely make a dent in your long-term care coverage.

Many seniors mistakenly think that Medicare will pay for their long-term care, when in reality it only covers a fraction of the services they’re likely to need. The biggest thing to know is that very few “unskilled” services (things like adult day care or home aide visits) are covered by Medicare, and even things like skilled nursing and hospital stays max out at 100 days.

Hybrid LTC policies have pros and cons.

If you’re turned off by the thought that you might never use the benefits in a traditional long-term care policy, a hybrid that combines LTC with life insurance might be more appealing. Such policies secure a benefit no matter what — either in the form of care for you, or cash for your loved ones. There’s also no danger of premiums going up unexpectedly.

However, there are trade-offs. For one, most hybrid products have a higher upfront cost: They require either a large one-time payment, or a shorter set payment term (10 years is typical). And even if you have the cash available (a meaningful LTC benefit will require between $50,000–$75,000 in total premium), paying it sooner means it’s not available to earn interest elsewhere. And if you do end up needing care, the death benefit will decrease as a result, leaving your heirs with less.

As a general rule, though, you should address your respective needs for life insurance and long-term care insurance in their order of urgency. If you’re 55 or older and shopping primarily for life insurance, you may want to read our review on the best life insurance for seniors, but keep in mind that the accelerated death benefits we discuss may not cover all your long-term care needs.

The Bottom Line

Our Top Pick

Mutual of Omaha Robust coverage and flexible policies, plus standout provisions that come standard.

Shop around to find the best long-term care insurance for your budget. Since your insurance options and future costs vary according to where you live (as well as your health, age, and health history), working with an independent agent is often the best way to make sure you thoroughly compare your options. If you’re feeling overwhelmed, the Society of Financial Service Professionals can help you find a broker you can trust.