Long-term care costs can derail retirement plans. Here's how to manage them

Even the best-made retirement plans can fail, especially when unexpected health care costs crop up.

A recent study by Morningstar found that costs for long-term services and supports (LTSS), including things like in-home care, assisted living and nursing home facilities, can have a dramatic impact on retirement plan failure rates.  

To understand the impact of long-term health care costs, Morningstar researchers used a proprietary model of U.S. retirement outcomes to simulate two different groups: a baseline group where LTSS costs were incurred and a group where LTSS costs were set to $0.

In the first group, researchers found that 41% of households are projected to run out of money in retirement. That figure dropped dramatically in the second group, where there were no long-term care costs, to a 26% failure rate.

Who is at the greatest risk?

The study found that long-term care costs can vary drastically between men and women, as women tend to live longer and are more likely to require long-term care. A majority of single women (52%) were projected to run out of money in retirement, due in part to long-term care costs. When those costs were removed, the retirement failure rate for single women dropped to 34%.

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By comparison, roughly one in three single men were projected to run out of money, partially as a result of long-term care costs. In a group where no care costs were incurred, the rate of retirement failure dropped to 23%.

Factors like gender and family history may lead some people to forgo planning for long-term care costs. Financial advisors say that's a mistake.

"Although not all households will face a long-term care need, because we don't know who will need it, all must acknowledge it as a potential need and prepare accordingly," said Jessica McNamee, founder of Sirius Wealth Strategies in Bellefontaine, Ohio.

Preparing for long-term care costs

As the share of Americans age 65 and older rises over the coming years, demand — and costs — for long-term care are expected to rise. Misunderstandings about the health care system have left many Americans unprepared to cover those costs, the Morningstar researchers wrote.

Medicare does not cover long-term care costs, and while Medicaid does, individuals must meet strict financial and functional eligibility requirements to qualify.

For baby boomers requiring long-term care, costs can average nearly $250,000 from retirement age through death, according to Morningstar's research.

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"Given the high costs of LTSS and the strict eligibility requirements for Medicaid, private long-term-care insurance is an option for those looking to protect their assets," the researchers wrote. "However, the market is rather limited."

A relatively small portion of Americans — some 7.5 million — have such policies, leaving many to depend on personal savings or reduce their assets to qualify for Medicaid when care becomes necessary, the researchers wrote.

Michael Hausknost, secretary for the Orange County chapter of the Financial Planning Association, said that he recommends people purchase a long-term care (LTC) policy in their early 50s, when costs are lower.

"Speaking from experience, where my late wife and I dealt with her aunt's care and where I now care for my own mother, who is in a memory care facility, the well-documented high cost of these facilities is something few can afford, particularly in high-priced states," Hausknost said. "So, having an LTC policy to offset all or much of the cost is critical."

Alternatives to long-term care insurance plans

LTC plans are widely recommended by financial advisors to help protect against long-term care costs. But high premiums associated with these plans push many clients toward other solutions.

For ultrahigh net worth clients, advisors say that self-insuring can be a viable option. This can be particularly appealing for clients who don't believe they will incur long-term care costs, since they won't have to pay any LTC insurance premiums. However, if a client decides to go this route, they should have at least $1 million set aside for care costs, Hausknost said.

Unpaid caregiving provided by family members can also help mitigate long-term care costs, but advisors are typically skeptical of that as a solution on its own.

"I insist every client of mine have a plan of how care would be provided," said John Power, a financial advisor at Power Plans in Walpole, Massachusetts. "And if the plan is 'my daughter,' I want them to have a documented agreement to that plan."

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Advisors say that other instruments, like reverse mortgages and certain life insurance policies, can also help retirees without LTC insurance to cover costs.

"The use-it or lose-it nature of most insurance policies has led us to implement permanent life insurance policies with long-term care riders — for the appropriate situation — over the past several years," said Tyson Sprick, a financial advisor at Caliber Wealth Management in Overland Park, Kansas. "For someone who is likely passing on assets to their heirs anyway, this strategy enables them to do so in a tax-efficient way while also being able to tap into that death benefit for long-term care needs during their life, if necessary."

While insurance plans are common, long-term care planning can be achieved in several ways, said Kris Etter, founder of Beacon Financial Planners in Houston, Texas. 

"It is our job to educate our clients on each one that may be suitable for them," he said. "Just this week, we discussed reverse mortgages with two couples. Prior to 2012, if a client asked me about a reverse mortgage, I would have suggested they fire me. While they are not for everyone, they can be the Swiss Army knife in a retiree's toolbox. LTC is just one option they solve for. We don't ask clients, 'Do you have LTC insurance?' We ask 'What is your LTC plan?'"