By Marc Gilman
(800) 927-9326 |
“Should I buy long-term care insurance?” doesn’t have a single right answer — and honestly, anyone who tells you it does is oversimplifying. Some respected voices in this space say nearly everyone over 60 needs it. Serious academic research says only a minority of buyers actually come out ahead financially. Both are working from real data. This post walks through who genuinely fits the profile, who doesn’t, and why the disagreement exists in the first place.
Key Takeaways
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The clearest fit is someone in their mid-50s to mid-60s, in good health, with enough assets to not want Medicaid as a fallback plan but not so much they can comfortably self-fund years of care.
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Massachusetts’s own Division of Insurance is explicit that not everyone is a candidate — and lists specific reasons you should not buy, including limited assets or income that’s only Social Security or SSI.
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Certain health conditions and current functional limitations (already using a wheelchair, walker, or needing help with daily activities) will disqualify most applicants outright.
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Serious research disagrees on whether long-term care insurance is a good financial bet for the average person — and that disagreement is worth understanding, not glossing over.
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Non-financial factors — wanting choice over your care setting, not wanting to burden a spouse or adult children, lacking nearby family who could provide informal care — are legitimate reasons to buy even when the pure math is a toss-up.
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Affluent buyers shouldn’t assume they’re automatically a poor fit — “average” cost data may understate what it would take to maintain their actual standard of living in care.
Who Should Seriously Consider Buying?
The clearest fit, across nearly every source on this topic, is the same: someone in their mid-50s to mid-60s, currently in good health, who falls in a specific wealth band — enough assets that Medicaid’s spend-down requirements would be a real loss, but not so much that self-funding years of potential care is a non-issue. Massachusetts’s Division of Insurance describes this directly: you may want to consider buying if you have significant assets and income, want to protect some of that wealth, want to pay for your own care, and want to stay independent of relying on others.
Married couples are also a particularly good fit — insurers often discount policies bought together, and the risk this product addresses (one spouse’s care needs draining both spouses’ shared assets) is exactly the scenario a single-person retirement plan usually doesn’t anticipate.
Who Should NOT Buy Long-Term Care Insurance?
This is where a lot of marketing goes quiet, but Massachusetts’s own consumer guidance doesn’t: you should not consider buying if you can’t afford the premiums, have limited assets, rely only on Social Security or SSI as income, or regularly struggle to pay for utilities, food, or medicine. This isn’t a minor caveat — it’s official regulatory guidance, and it exists because long-term care insurance is a 15-, 20-, sometimes 30-year premium commitment. A policy you can’t sustain, or one that competes with your ability to cover basic needs today, isn’t protecting you from anything.
If you have very limited assets to begin with, Medicaid planning — not private insurance — is usually the more realistic path. We’ve written separately about how that works in both New Hampshire and Massachusetts.
What Health Conditions Typically Disqualify You?
Long-term care insurance is medically underwritten, not guaranteed issue. Insurers vary in their specifics, but conditions that commonly result in a declined application include Alzheimer’s disease, dementia, Parkinson’s disease, multiple sclerosis, ALS, cancer, kidney failure, and a personal or family history of certain neurological conditions. Beyond diagnoses, already needing help with daily activities — bathing, dressing, eating, or using a cane, walker, or wheelchair — will disqualify most applicants regardless of the underlying cause.
This is really the core argument for buying earlier rather than later: it’s not just that premiums rise with age, it’s that a health change between your mid-50s and your mid-70s can take the option off the table entirely, at any price.
Does the Math Actually Favor Buying?
Here’s where honest sources genuinely disagree, and it’s worth sitting with rather than smoothing over.
Industry-facing sources often lead with statistics like “70% of people turning 65 will need long-term care” and nursing home costs exceeding $100,000 a year — both true, and both used to argue that insurance is close to a financial necessity.
But two independent research efforts complicate that picture. A Boston College Center for Retirement Research study found that nursing home stays are typically shorter than assumed (11 months for a single man, 17 months for a single woman) and, after accounting for Medicare and Medicaid’s role in paying for some of that care, estimated that only about 19% of men and 31% of women actually come out financially ahead by buying a policy. Separately, RAND Corporation research cited in Forbes found the average long-term care cost per person is only around $7,000, with just 5% of older adults incurring long, expensive stays of $47,000 or more.
Neither finding means long-term care insurance is a bad idea — both studies have real limitations (they lean heavily on nursing-home-only data, when home care and assisted living are actually the more common use of benefits, and “financial benefit” isn’t the only reason people buy insurance). But it does mean the “everyone needs this” framing oversells the case for a meaningful share of buyers. If your decision is being driven purely by fear of the worst-case statistic, it’s worth knowing the worst case is genuinely uncommon — even though it’s real, and can be financially devastating for the people it happens to.
What About Reasons Beyond the Math?
The financial research above assumes the only reason to buy insurance is to come out ahead in dollars. Most people don’t buy insurance that way — you don’t buy home insurance hoping your house burns down to “get your money’s worth.”
A few non-financial reasons show up consistently across sources: wanting the ability to choose your care setting rather than defaulting to whatever Medicaid-approved facility has availability; not wanting a spouse or adult children to become your unpaid caregivers (roughly 80% of home care today is provided by unpaid family, and a third of caregivers report real financial strain from it); and simply not having nearby family who could realistically provide that care in the first place. If any of those describe your situation, the “only 19-31% benefit financially” statistic matters less than it might seem.
What About High-Net-Worth Buyers?
There’s a common assumption that if you’re affluent enough to self-fund care, you don’t need this insurance. That’s not automatically true. National average cost data — the kind used in most of these calculations — describes an average facility. It doesn’t describe the concierge-level home care, premium continuing-care community, or specific quality of care someone with real wealth might actually want. Self-funding based on “average” costs can genuinely understate what it would take to maintain your actual standard of living during a care event, which is a different (and easy to miss) risk than simply running out of money.
This is also where hybrid life-insurance-and-LTC products tend to fit particularly well — they avoid the “use it or lose it” downside of traditional policies, since unused benefits still pay a death benefit, which matters more to buyers who might never need care but don’t want premiums simply gone if that’s the outcome.
When Should You Buy?
There’s genuine, reasonable disagreement here too. The American Association for Long-Term Care Insurance points to the mid-50s as the best age to buy, since premiums are lowest and health is generally best. Other voices argue for waiting until 60, pointing out that roughly 92% of claims are filed by people over 70, with most starting after 80 — meaning a decade of extra premiums in your 50s may not buy you much.
Both are reasonable positions built on real data. The practical takeaway: if you’re healthy and in your mid-50s to mid-60s, you’re in the window where this decision is genuinely available to you. Waiting significantly past that starts trading on both higher premiums and real underwriting risk.
What Protections Does Massachusetts Provide Buyers?
If you’re purchasing in Massachusetts specifically, state law gives you protections that don’t exist everywhere. Individual policies must be guaranteed renewable, can’t have an elimination period longer than 365 days, can’t exclude pre-existing conditions for more than six months, and must offer at least one policy with home health care benefits. Massachusetts also explicitly prohibits “post-claims underwriting” — insurers digging into your health history only after you file a claim, then denying it based on what they find. And if part of your goal is protecting a home from MassHealth’s eligibility and estate recovery rules, a policy needs to meet specific minimum standards (at least 730 days of nursing home coverage, at least $125/day in benefits) to qualify for those exemptions.
Where Does Insurance Planning Fit In?
Long-term care insurance is a genuinely complex product, and the right answer depends on your health, assets, family situation, and what you’re actually trying to protect against — not a one-size-fits-all statistic. Gilman Agency can walk through how a potential policy fits alongside your Medicare coverage and broader financial picture, and help you understand the questions worth asking before you apply.
What To Do Next
If you’re in your mid-50s to mid-60s, in good health, and have assets you’d genuinely like to protect, this is worth a real conversation now — waiting costs you both in premiums and in the risk of becoming uninsurable. If your financial situation looks more like the “should not buy” list above, Medicaid planning is likely the more realistic path, and that’s a conversation too.
Call (800) 927-9326, or email to talk through your situation. TTY: 711.
By Marc Gilman, Gilman Agency
Sources: National Council on Aging, “How Much Does Long-Term Care Insurance Cost and Is It Worth It?”; Protective Life, “Pros and Cons of Long-Term Care Insurance”; Massachusetts Division of Insurance, “Do You Need Long Term Care Insurance”; Center for Retirement Research at Boston College, “Fewer Need Long-Term Care Insurance”; Forbes (Steve Vernon, FSA), “Should You Buy Long-Term Care Insurance?”; RAND Corporation; American Association for Long-Term Care Insurance (AALTCI); Kaiser Family Foundation; U.S. Department of Health and Human Services; U.S. Administration for Community Living.
