Long-Term Care Insurance in New England
Health insurance pays your doctor and hospital bills if you get sick or injured. But it does not cover the cost of long-term care — the ongoing assistance you would need if a chronic illness, disability, or the effects of aging left you unable to care for yourself for an extended period. Long-term care insurance is designed to cover that gap.
Long-term care goes beyond medical treatment. It encompasses all the assistance you could need with daily activities — bathing, dressing, eating, moving around — whether that care is provided in a nursing home, an assisted living facility, or in your own home. It is not only a concern for the elderly: a young or middle-aged person who has been in an accident or suffered a debilitating illness may also need long-term care services.
Massachusetts and New England have some of the highest long-term care costs in the country. Planning ahead — before you need the coverage — gives you the most options and the most affordable premiums.
What Does Long-Term Care Insurance Cover?
Long-term care insurance includes:
- Nursing home care: skilled nursing facilities and custodial care for individuals who need ongoing assistance with daily living activities
- Assisted living: residential care facilities that provide help with daily activities while allowing residents to maintain some independence
- In-home care: personal care aides, homemaker services, and other assistance that allows you to remain in your own home while receiving care
- Adult day care programs and other community-based care services
Long-term care policies typically pay a daily or monthly benefit up to a maximum lifetime benefit amount. Policies may include an inflation protection option, which increases the benefit over time to keep pace with rising care costs — an important feature given that long-term care costs have historically increased faster than general inflation.
Frequently Asked Questions
Does Medicare cover long-term care?
Medicare covers limited skilled nursing facility care following a qualifying hospital stay — specifically, up to 100 days, with significant cost-sharing after the first 20 days. It does not cover custodial care (help with daily activities) when that is the only type of care needed, which describes the majority of long-term care situations. Medicaid does cover long-term care costs, but only after you have spent down most of your assets to qualify. Long-term care insurance protects your assets before a Medicaid spend-down becomes necessary.
How much does long-term care cost in Massachusetts?
Massachusetts is consistently among the most expensive states for long-term care. The annual cost of a private room in a Massachusetts nursing home now averages more than $175,000, according to Genworth and Care Scout’s Cost of Care Survey. The cost of in-home care aide services for a full-time schedule can run $80,000 or more per year. Even a few years of care at these rates can substantially erode a retirement savings plan. Long-term care insurance is designed to transfer that financial risk to an insurer rather than absorbing it out of personal assets.
When is the right time to buy long-term care insurance?
The best time to purchase long-term care insurance is when you are in your mid-50s to early 60s — old enough to take the need seriously, young enough to qualify at preferred health rates. Premiums increase significantly with age, and a health condition that develops later in life can make coverage unavailable. Waiting until you are older or have already experienced a health event often means paying more or being declined. Cleary recommends discussing long-term care planning well before it feels urgent.
What is the difference between traditional long-term care insurance and hybrid policies?
Traditional long-term care insurance is a standalone policy that pays benefits if you need covered care and lapses if you never use it. Hybrid policies combine long-term care benefits with a life insurance or annuity structure: if you never need long-term care, the death benefit passes to your beneficiaries, so the premium is not “lost.” Hybrid policies are generally more expensive upfront but provide a guaranteed benefit regardless of whether long-term care is ultimately needed. Cleary can compare both structures based on your financial situation.
Does long-term care insurance cover in-home care?
Yes. Most long-term care policies cover in-home care as well as facility-based care. In-home care allows many individuals to remain in their own homes while receiving assistance, which is both a preference for most people and often a less expensive option than facility care. Policies typically require that you meet a benefit trigger — usually the inability to perform a defined number of activities of daily living (ADLs) without assistance — before benefits begin, regardless of the setting.