Is Catastrophic Insurance for Long-Term Care Beneficial?

For some time, researchers have been studying the benefits of Catastrophic Insurance for Long-Term Care. These are plans that meet the requirements of Qualified Health Plans (QHP) but do not cover any other benefits other than 3 primary care visits per year until the deductible is met. The monthly premiums are lower, however the out of pocket is significantly more for deductibles, co-pays, and co-insurances. To be eligible applicants must be under 30 years old or qualify for “hardship exemption” (determined by the marketplace).

A Study funded by the SCAN Foundation, LeadingAge, and AARP and researched by The Urban Institute and Milliman, analyzed the impact of LTC policies using recent demographic data.  They modeled several insurance options giving policy makers and stakeholders the ability to look at the possibility of affordable options. LeadingAge published a report about these studies in November of 2015 explaining the impact of paying for LTC and possible outcomes of the new policies.

  • $182,000 – the average amount a woman can expect to pay in LTSS as she ages ($91,000 for men).
  • 52% of Americans who reach age 65 will someday need a high level of help with everyday activities.
  • Families are spending over 100 billion dollars a year, covering about half of paid care directly.


“We are excited and optimistic about what the results from this study reveal: there are options that can help the family pocketbook, help the taxpayer, and relieve the Medicaid financial burden,” said LeadingAge President and CEO Larry Minnix. “The bad news is that our aging society will have problems they don’t know they will encounter. But the good news is that there are solutions to help people plan better and relieve financial pressure.” —  LeadingAGE

Michelle Andrews published an article, Catastrophic Insurance Could Help With Long-Term Care Expenses: Studies on Kaiser Health News that explains the two programs and the impact they could have.

“The first would pay at the beginning — 90 days after someone needed help with at least two “activities of daily living” — for up to two years, while the second would pay at the end — for an indefinite period — after someone had needed assistance for at least two years.” — Michelle Andrews

These models both present benefits but costs and political differences have prevented any progress. The Urban researchers stated that more research is needed but these models “could reduce Medicaid spending, providing financial relief to hard-pressed states” and “reduce out-of-pocket spending for families.”