Why I Won’t Buy Long-Term Care Insurance

Note:  My Dad passed away on 18 November 2017 from end-stage Alzheimer’s.  This post is about my experiences with his insurance during the years 2011-2014.

There are hundreds of posts on the pros and cons of long-term care insurance, but most of them approach the question from a financial perspective. Today we’re going to look at other aspects of the decision: statistics, lifestyle, the process, and the lessons that I’ve learned.

Another reason I’m writing this 2500-word post is because I’m disgusted by John Hancock Life Insurance Company’s latest attempt to exploit their beneficiaries and caregivers. My father is finally finished with their long-term care policy and I feel free to describe why I’ll never do business with them.

But first let’s look at the statistics. You’ve seen the dire warnings on every insurance and financial website: someday you’ll need skilled care in a nursing facility, and you’ll have to protect your finances with long-term care insurance.

As usual, the facts are more complicated than the sound bites.


Last month a new study on long-term care risks was published by the Center for Retirement Research at Boston College. (That link opens a PDF.) The research was funded by a grant from the National Institute on Aging, part of the Department of Health and Human Services, so I’m going to call it “objective”.

The paper’s background is the most illuminating part of the study. The typical statistics and probabilities quoted for long-term care insurance marketing are based on survey data that’s over 25 years old. That data identified the “long-term care insurance puzzle”: only 13% of wealthy people purchase the coverage, even though over 30% of men and 40% of women can afford it. A large crowd of informed consumers should be more rational, so the puzzle was thought to be caused by ignorance of the risk or by poor product design.

The latest survey data shows a different story: a higher risk of using long-term care, but a shorter stay in a facility. Among people over 65 years old, 58% of women and 44% of men are expected to need long-term care at some point. However, the new data shows that each stay in a facility tends to be shorter than previously predicted– and a significant amount is covered by the 100-day limit of Medicare.

The reality matches the new data: fewer than 5% of today’s elders are living in full-care facilities, and only about 20% use paid home-care assistance. Our families are either stepping up to provide care, or care isn’t needed for very long.

Insurance companies have used the older data to set their long-term care policy parameters and premiums. On the premium table of the Federal Long-Term Care Insurance Program, the payments start rising faster for ages above 60. The implication is clear: buy the insurance now while you still qualify for cheap rates. Even if you’re paying for a longer time, you’ll still pay a lower total of premiums. In the last 25 years, millions of clients did the math on this fear marketing.

As people lined up to buy policies (with inflation riders), the insurance industry discovered that they’d made two horrible mistakes:

Federal Long-Term Care Insurance Program logo | The-Military-Guide.com

Click the logo for a premium chart.

Those issues have largely been corrected in today’s policy premiums (and many smaller insurers left the sector) so long-term care insurance is more expensive today than ever before. When John Hancock took over as the sole provider of the FLTCIP in 2010, premiums jumped up 25%.

The financial industry has also acknowledged their problem by creating new hybrid policies that combine life insurance or annuities with long-term care riders. If you thought policy-shopping comparisons were tough before, it’s even more complicated today.

So we’re living longer than ever, and long-term care policies cost more than ever, and the policies are more complicated than ever, and those premiums are still rising– yet we’re using less long-term care than we thought.


No, we’re not going to talk about aging with dementia. We’re going to discuss caregiver lifestyle.

My father first noted his cognitive decline (privately) over seven years ago. Today he’s deep into mid-stage Alzheimer’s in a full-care facility, but back then he made his wishes clear: do not resuscitate. Years ago his cognitive self decided that when his time came, he only wanted palliative care. Today his short-term memory is measured in minutes but all of his needs are met. As far as he can tell, life is awesome. When awesome stops, hospice will step in.

My brother and I have the world’s best possible caregiver situation. I’m financially independent and his small business will soon do the same for him. We’re largely in control of our time, and Dad is in one of Denver’s top-rated care facilities. I’ve read extensively about caregiver stress at Alzheimer’s Reading Room and in books, and our stress is barely a 1 on a scale of 10. Maybe 0.5.

Yet we still drive ourselves nuts.

My brother and I both beat ourselves up for not spending more quality family time with Dad over the years (even though Dad chose his hermit lifestyle). My brother visits several hours each week with Dad and shops for his personal needs like clothing and toiletries or new jigsaw puzzles.

We both frequently talk or e-mail with the care staff. I rarely visit but I spend at least an hour a week taking care of his finances and the probate court’s conservator reports. When Dad has a medical issue, we both swing into full-time crisis-response mode to handle the logistics and the billing. I may be retired from the military, but I’m still on duty: we have to be ready to drop everything and race to Dad’s side to make sure he’s taken care of and that his DNR wishes are respected.

And yet our caregiver responsibilities are laughably light compared to the national norm.

Home care for elders is extremely stressful on the families. Constant vigilance and caregiver burnout lead to lack of sleep, poor diet, high blood pressure, cardiac stress, and a rapid decline in health. Delegating the labor to paid home care staff trades the physical effort for the challenges of supervising the logistics, fretting over the quality of care, and perhaps even feeling guilty at not being able to do it all for our loved one. “Respite” care periods are spent catching up on other essentials in order to be more ready to devote more caregiving time. In a few cases the caregiver ends up nearly as disabled as their charge, and they have a higher mortality risk.

I’m not going to link a bunch of caregiver statistics in this section. Numbers can’t adequately describe the physical burdens and mental stress of caregiving. Instead I recommend that you talk to just about any of your family who are in their 50s or 60s. We all know someone who’s caring for an elder, but we just don’t feel comfortable talking about it.

I’m a fairly capable person with the time (and the ethics) to responsibly handle someone else’s finances, yet it’s still a significant effort. In the middle of caregiver chaos, I don’t know how anyone manages to track the expenses and project the finances. When it’s routine, it’s still a perpetual chore. Caregiver financial ignorance is all too common, bureaucracy runs rampant (with more ignorance), and fraud is a constant risk. When there’s a crisis, paying the bills is probably the lowest item on the priority list.

In some ways the person with dementia has it easier than anyone around them. Today my father is the happiest he’s ever been, because Team Nordman is taking care of him.

Which brings me to John Hancock’s latest outrage.

Tracking the process

Three years ago by the time I filed Dad’s long-term care insurance claim, everyone around him knew that he had dementia. He had a doctor’s diagnosis and the care facility’s assessment of his abilities.

John Hancock denied the claim because Dad scored too well on the Mini Mental State Exam, a rapid assessment of dementia severity. They also claimed that he didn’t need enough help with the activities of daily living. They said that they’d need a more thorough assessment for a claim appeal, so I hired a neuropsychologist. After a two-hour interview with Dad (and nearly $4000), the doctor’s assessment finally “proved” the status quo to John Hancock’s insurance claims department.

For the last three years, the insurance company has paid the claim through a laughably archaic and labor-intensive procedure.

All business with them was initially handled via phone, fax, and postal mail. Again, I have the time to jump through these hoops and I’m fairly persistent. However, the monthly paperwork shuffle was a hassle, as was the tracking. For the first 18 months Hancock even insisted on sending a paper check through the postal mail, even though several pieces of mail had been lost and I was concerned about mailbox theft. They finally began electronically depositing the payments to Dad’s checking account, but they still mailed out paper confirmations instead of using e-mail or a website.

There was so much paperwork (just like the 1980s) that I finally took the time to put together a spreadsheet to track the payments: when invoices were received, when they were faxed, when the check arrived, and the total paid on the claim. (The insurer’s monthly confirmations did not include this information.) I projected when the policy would reach its payout limit, and I knew how much the last payment should be.

As the policy approached its limit last month, John Hancock never sent any alerts or other notices. Instead, one day a small payment was deposited in Dad’s account. Five days later the letter arrived in the mail:

“We have determined that all benefits eligible under your Long-Term Care Policy have been exhausted. This is based on benefit payments issued from 6/17/2011 to 10/5/2014. An exhaustion of benefits means that the policy limit […] has been paid out in full with no benefits remaining. All benefits eligible under your policy have been paid as of the service date of 10/5/2014. […] Since your long-term care policy limit has been exhausted, no further benefits are due under this policy.”

There was no other documentation or statement summary– just that one-page letter and a toll-free phone number for questions.

Seems pretty straightforward, right? If you were an exhausted overwhelmed, stressed, sleep-deprived caregiver then you’d probably shrug your shoulders, file the letter, and move on to the next crisis.

Except that I knew John Hancock’s numbers were $6,175 short. That’s only about a month of care over more than three years, but their letter didn’t refer to the policy’s original amounts (and inflation adjustments) to justify their statement. I couldn’t even reverse-engineer their math to arrive at a sensible answer, and as far as I can tell they were just makin’ stuff up. I still don’t know how they determined that they’d reached the cap, but I had Dad’s copy of the policy and I can punch calculator buttons.

So I spent an hour writing a letter, collecting and attaching the documentation, and stuffing it all in a $5 priority-mail envelope. I asked them to please justify their numbers or to send $6,175. I tracked the envelope’s progress on the U.S. Postal Service website until it was logged at John Hancock’s claims department.

19 days later, $6,175 was deposited to Dad’s account. Five days after that I got a one-page letter from John Hancock– no phone calls, no e-mails, nothing else. The letter said

“Based on a review of the file, we are honoring your request for payment of $6,175.”

No other explanation. Not even a “thanks for insuring with John Hancock”, let alone an apology. I had to “request” that they pay the money that their policy owed to Dad?!?

How many caregivers have the time, energy, organization, or persistence to question the big insurance company? If John Hancock cuts off just 100 beneficiaries a month by $6,175 then they “save” nearly $7.5M annually. If the state insurance commissioner asks them about a client complaint, they can simply say “Ooops” “Based on a review, we’re honoring the request for payment”. It’s not a conspiracy when you’re incompetent– you just have to convince the clients (and the authorities) that you merely made a dumb mistake. And apparently you don’t even have to express regret at the way you’re running your business.

Lessons learned

So what have I learned from this experience?

I’ve learned not to trust long-term care insurance policies. They’re based on flawed math and they’re still catching up to reality.

I’ve learned not to trust long-term care insurance companies. At best they’re inadequately informed and inappropriately motivated by market share and commissions. (Imagine if their salaries were based on customer satisfaction surveys.) At worst they’ve learned to sell through fear marketing. They’re still losing money on long-term care insurance policies (as far as they can tell).

It’s not “insurance” when a beneficiary’s claim is denied and caregivers have to fight for every dollar. It’s not “insurance” when you have to understand and track the benefits better than they do, and when you have to communicate the policy status more than they do.

I’ve learned that we need a better approach to long-term care. I’ve read many bold polemics over the years about “accidental overdoses” and “health insurance by Glock”, and I still have my Hemlock Society membership card.

However, I’m still skeptical. I’d rather die in my sleep, and my spouse assures me that could happen. My thoughts will keep evolving, but I favor slow medicine. I think my DNR and hospice are as far as I’m interested in prolonging my life.

I’ve learned that lifestyle is at least half of the cause of dementia, and I can tilt the odds in my favor. (I can’t change my genetics.) I can improve my cardiac fitness, my blood pressure, my weight, and (*sigh*) my sugar consumption. I live in the healthiest state in the nation. Living a healthier lifestyle will improve my life and my finances. I’m a nuke– I can take logs and track data. The good news is that all of those things will improve my surfing, too.

I’ve learned that health tech is a better use of my money than LTC insurance. I don’t insist on “aging in place” or “living independently”. However, I think that safety sensors, health monitors, assistive equipment, and perhaps even robots will reduce caregiver stress. Insurance companies are not reducing caregiver stress.

I’ve learned that I don’t want my spouse or our daughter to grapple with insurance companies on my behalf. If I need long-term care, their lives will be stressful enough. Dealing with long-term care insurance has failed to make life better for its beneficiaries and their caregivers.

I’m spending my money on the things that bring real value to my life. So far that is not long-term care insurance.

Related articles:
Book review: “When The Time Comes”
Interview: What’s Wrong With Long-Term Care Insurance?
Geriatric Financial Management Update (John Hancock business practices)
More Lessons Learned On Insurance (the last few paragraphs)

About Doug Nordman

Author of "The Military Guide to Financial Independence and Retirement" and co-author of "Raising Your Money-Savvy Family For Next Generation Financial Independence."
This entry was posted in Financial Independence, Insurance. Bookmark the permalink.

21 Responses to Why I Won’t Buy Long-Term Care Insurance

  1. Rob @ The Military Financial Planner says:

    Great piece! Your comment, “I’ve learned not to trust long-term care insurance companies” reminded me of another issue: people putting their retirement or college savings into insurance policies rather than the stock market.

  2. Mike says:

    I’m not ordinarily a commenter on blog posts but this one struck me. You state you don’t trust long term care insurance companies as result of your experience but what makes you think all other insurance companies act any differently. They succeed by collecting as many premiums as possible and paying out as little as possible. As you noted all they have to do is “short change” everyone by a relatively small and unnoticeable amount and they profit big time. I don’t trust any of them and use them as sparingly as possible. Keep up the good work.

  3. Kate says:

    Doug, I appreciate this piece and your willingness to share. As my siblings and I watch my mother struggle to care for her mother-in-law, we have been discussing purchasing long-term care insurance on Mom. None of us think we have the right combination of patience, nursing, and general fortitude to take on the huge responsibility of caring for an older person. You’ve just added a lot more to think about…

    • Doug Nordman says:

      Thanks, Kate, it’s a tough decision ,and at least you guys are talking about it now. I strongly recommend the book “When The Time Comes” along with Paula Span’s “New Old Age” blog on the NYT.

      I’d like to buy a policy that’s financially sound from an insurer who I trust to effectively manage the funds. Unfortunately that product does not seem to exist yet.

  4. Peter Gregory says:

    These are the facts. 70% of medicare/Medicaid dollars are spent on the last 18 months of life. The average time a person 65+ will spend in a managed care/nursing facility is about 7 months prior to death. LTC is not so much about quality of life, as it death and disease management. The financial miscalculation of the Insurance industry was to assume the baby boomers would be scared enough to buy LTC in their 50’s and all would get fat premiums paid while knowing full well the actuarial and mortality tables were in the Industries favor. Lesson. Save your money, invest in good health now, and by the time the wave of Boomers hit their 80s and 90s, some aspect of the ACA will be in management of the LTC industry, not Met Life.

    • Doug Nordman says:

      Peter, those may be the statistics now, but they’re changing. I was surprised to see how much of today’s LTC sales info is based on 25-year-old numbers. I suspect that your facts are aging badly, too.

      The industry got the premiums they asked for. I just wish they’d done a better job of estimating their expenses and not competed for market share by charging less. I want an insurance company to make a reasonable profit from my premiums, or else they’ll go out of business and not help me when I need it.

      I sure hope other companies step up in an ACA exchange. We need a more liquid market for long-term care insurance even if not everyone wants to buy it.

  5. Judy says:

    Thanks, again, for sharing your experiences, so that others may learn from them.

  6. Peter Gregory says:

    The big sea change in the insurance industry came about in financial deregulation in the 80’s. This is when the insurance industry began to diversify away from the plain vanilla life, auto, home products and began to develop financial engineering into whole, variable life insurance products, and what became the golden egg, various annuity product. LTC was just another means to tap into a product pool which they felt could be a financial wind-fall if they could get the math to work right. Now in the annuity market alone, which is in the trillions, more and more exotic and complex products are being offered everyday.

    With the retirement reform commission to report out next month, which will cause the greatest change in military retirement in 70 years ,the industry is more than ready to sell esoteric and complex annuity products to the military retired community which promises life time income for a lump sum deposit. And the pages of this web site will be devoted to the complexities of those offerings with the expected warnings and cautions.

  7. Joe Allets says:

    Agree 100% with this article, especially the advice to not trust the company. I had paid premiums for myself and my wife to the Federal Long Term Care program, to the tune of over $24,000. Just got notice of a rate increase. Mine went up 125% and my wife’s 138%. We are priced totally out of the market. So the $24,000 is just down the proverbial rat hole. I feel that this is a well planned fraud operation, with the idea being to take premiums for years, and then just about the time one might make a claim, raise the premiums so they can not afford to make the payments and have to drop the coverage. In our case, it’s $24,000 clear profit for the operators. One would not expect such from the Federal OPM, but there it is……….

  8. Bill Comfort says:

    Take a look at stretching your self-insurance dollars with a life insurance-linked LTC policy – many are remarkably simple … BUT make sure the LTC benefits are paid on a cash or “indemnity” basis (IRS calls this a “per diem” LTC benefit). No monthly receipts to submit.

    • Doug Nordman says:

      Thanks for the advice, Bill! I so want to believe that the industry has priced it correctly this time.

      And, yeah, if the indemnity basis means that the LTC benefits are not considered income then that sounds like a wonderful way for caregivers to worry less about the paperwork.

  9. Caroline says:

    This was an excellent article. In lieu of LTC Insurance, how would you suggest paying for such expenses. How much would you estimate would be necessary to self insure (accepting that you cannot fully remove the risk of need for long term care).

    • Doug Nordman says:

      Thanks, Caroline! I have high hopes for the industry’s new life insurance policies which include an optional long-term care rider. (Clients could use whichever part happens first.) However that still doesn’t solve the problems with claims processing and the payout bureaucracy.

      My father first noticed his cognitive symptoms in 2008 and managed to live independently until 2011, although (in retrospect) by late 2010 he was probably marginally safe. (And still refusing all help.) Between early 2011 and his death in late 2017 his care cost $625K. That averages out to just under $100K/year for everything in Denver, including his Medicare supplemental insurance policy, dental care, prescription co-pays, new clothes and dining/entertainment.

      Medicare paid for his hospitalization (perforated ulcer) which led to his move into a care facility. Medicare also paid for the first six weeks of rehab (the care facility is also a skilled nursing facility).

      Self-insuring is not easy to do because the costs vary so widely. Fidelity has estimated that end-of-life healthcare costs about $225K, but that number is several years old and that care is a highly individual experience. Dementia patients can live as long as 20 years (even with Alzheimer’s) but my father’s nine years is probably around the middle-long end of the bell curve.

      Your experience might be totally different. You might not need as much time in a care facility (especially if you have home care) and technology might reduce the expenses.

  10. Roger says:

    Great article Doug. Absolutely terrifying though. We just lost my Dad, also a veteran, to dementia and related illness after about a 5 year decline. Thankfully my wonderful sister had taken him in after my mother died 20 years ago and swore he would never go to a “facility”. She and her husband, along with help from friends and relatives made good on that promise. My wife and I are in our mid-60’s and are looking at LTC options since we have no confidence that our kids can help when the time comes. There just seem to be no good options. I’m an AF retiree so am eligible for FLTCIP, but it seems like a terrible thing after reading your article. The ACA seems to be getting weaker instead of expanding. Combination insurance/LTC policies seem to be a crap shoot at this point with extreme complexity and benefits that are all over the map. Is there any professional group of experts on LTC out there that people in our situation can ask for advice – that actually have our interest at heart and aren’t just commision based schills? Also, since this article is 4 years old, has anything changed enough so that you would recommend a specific course of action now?

    • Doug Nordman says:

      My condolences on your father’s death, Roger.

      I agree with you about the choices. The “worst” part about the FLTCIP is their ability to raise the premiums (or cut benefits). People drop their insurance policies when rates are increased, which artificially raises the lapse rate of that cohort and helps the policies avoid further losses. Many state insurance commissioners have laws against raising premiums on a LTC policy cohort, but FLTCIP is a federal program.

      I agree with the crap-shoot aspect of the hybrid life-insurance/LTC policies. However they seem to be a better way for the insurers to make money, which might be the only way the industry can survive. Insurers charge higher (whole-life) premiums for the life insurance and hope that you either never need the LTC (the “die early” option) or else die quickly once you’re in a care facility. Of course the only people who buy these policies are people who suspect that they’re going to need LTC. The insurers understand that now, which is why the policies are so complex and varied.

      The best resources for the latest info seem to be the Bogleheads forum and Early-Retirement.org. I’ve been a member of both for 10 and 15 years, and the discussion will lead you to people in your state who’ve done their research. From there you can get referrals to fee-only CFPs and insurance brokers. You could also check their quotes against USAA, although USAA might not have the best policy benefits. USAA has great member service but they frequently contract out their LTC policies to Metlife or John Hancock.

      The only change in the last four years (besides further consolidation in the LTC insurance industry) has been the adoption of principle-based reserves for life insurance.
      That might lower the premiums a little on a hybrid policy. Even so I’d still check with your state regulators to see an insurance company’s complaint record. You want to have a fair experience when you file a claim.

      The bell curve of Alzheimer’s survival extends out to 20 years, but its median seems to be about 3-4 years. My father’s 6.5 years of care cost a grand total of $625K, which included Medicare supplemental insurance premiums and prescription copays and (later) a memory care facility. Dad’s LTC insurance policy covered about half of that expense.

      Because of the stress of LTC insurance claims on caregivers, my spouse and I are self-insuring for our LTC. Our military pensions (and our Social Security benefits at age 70) will defray most of the expenses of a care facility. That should give us a long time in a private-pay facility before needing to file for Medicaid.

Please leave a comment here!

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s