By Marc Gilman
Questions? Call (800) 927-9326 or email
Key Takeaways
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Traditional long-term care insurance gets harder to qualify for with age — roughly 44% of applicants aged 70–74 and over half of applicants 75+ are denied, according to industry data.
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It’s not hopeless. Hybrid policies, short-term care plans, and long-term care annuities are all real alternatives with more forgiving underwriting.
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Only about 3% of Americans over 50 carry long-term care insurance, yet 14% of people 65 and older will eventually face over $100,000 in out-of-pocket long-term care costs that Medicare doesn’t cover.
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New Hampshire has a Long-Term Care Partnership program offering dollar-for-dollar Medicaid asset protection. Massachusetts does not — but it has its own separate exemption for a MassHealth-qualified policy.
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Before shopping for coverage, get clear on what kind of care you want, where, and from whom — the funding plan should follow that decision, not the other way around.
Why This Gets Harder — But Not Impossible — After 70
Long-term care insurance is priced almost entirely on the age you buy it, and underwriting tightens considerably the later you wait. Certain health conditions — including significant memory loss, kidney failure, and liver cirrhosis — can make approval for a traditional policy effectively out of reach.
That doesn’t mean there’s nothing left to do. It means the conversation shifts from “which traditional policy fits my budget” to “which of several alternative structures still fits my situation.”
What Are the Real Alternatives at This Age?
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Hybrid policies — combine life insurance or an annuity with long-term care coverage. Underwriting is typically more forgiving than traditional LTC insurance, and if you never need care, your beneficiaries still receive a death benefit. For many people in their 70s, this ends up being the most realistic path to real coverage.
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Short-term care plans — cover a limited duration, often up to about a year. Medical underwriting is usually less strict, which makes these more accessible even with some health history. They won’t cover an extended care need, but they can absorb the cost of a brief, intensive one.
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Long-term care annuities — a deferred annuity that also provides long-term care benefits, often two to three times the annuity’s value if used for care. If care is never needed, the remaining value passes to your estate.
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Paying out of pocket — the most flexible option in terms of care choices, but it requires real savings and a deliberate plan rather than hoping it works out.
Why Where You Live Changes the Math
This is the part that gets skipped in most general advice, and it matters a lot depending on which side of the Massachusetts–New Hampshire line you’re on.
New Hampshire participates in the federal Long-Term Care Partnership program. If you own a Partnership-qualified policy, New Hampshire Medicaid will disregard assets on a dollar-for-dollar basis equal to whatever your policy pays out in benefits. A policy that pays out $200,000 in care benefits shields $200,000 of your assets from the Medicaid spend-down calculation — on top of the coverage itself. It also protects those assets from Medicaid estate recovery after death.
Massachusetts does not participate in the Partnership program — it’s one of a handful of states that opted out. But Massachusetts has its own separate protection: if you own a MassHealth-qualified long-term care policy, meeting specific requirements (generally, covering at least $125 per day for at least 730 days, with no elimination period longer than 365 days), you can be exempt from certain MassHealth eligibility and estate recovery rules — even without the dollar-for-dollar Partnership mechanism New Hampshire offers.
The bottom line: the type of policy that makes financial sense can genuinely differ depending on which state you’re in, which is exactly the kind of detail that’s easy to miss shopping for coverage online.
What Should You Actually Do Before Shopping for Coverage?
A few steps make the eventual decision much clearer:
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Decide what kind of care you’d actually want, and where — home-based care, assisted living, or a skilled nursing facility — since that shapes which product actually fits
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Build a realistic retirement budget first, then see what you can genuinely afford to add in premium
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Shop multiple carriers and product types, not just one — traditional, hybrid, short-term, and annuity-based options all price and underwrite differently
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Read the fine print carefully: daily/monthly benefit amount, benefit period length, and whether the policy includes inflation protection
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Understand how claims are paid — reimbursement (you submit receipts) versus indemnity (a fixed payment regardless of actual cost) work very differently in practice
What To Do Next
Being in your 70s makes long-term care planning harder, not impossible — and the right next step depends heavily on your health, your budget, and which state’s rules apply to you. Massachusetts and New Hampshire residents are genuinely working with different tools here, which is exactly the kind of detail worth getting right before you commit to a policy.
If you want to walk through which option actually fits your situation, reach out and we’ll look at it together.
Questions? Call (800) 927-9326 or email
