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Long-Term Care Income Planning FAQs

Please reach us at info@careincomeplanning.com if you cannot find an answer to your question.

Long-term care is the help you may need if a chronic illness, disability, or the normal effects of aging make it difficult to manage everyday activities on your own. 


This can include things like bathing, dressing, eating, or getting around safely. Care can be provided at home, in an assisted living community, or in a nursing facility. 


Unlike traditional health insurance or Medicare, long-term care is focused on support and services over time - not curing a condition. It’s about making sure you have the help, dignity, and independence you need when life changes. 


Care Income Planning is the process of making sure you have a reliable stream of money set aside specifically for long-term care needs - without draining your regular retirement income. 


Think of it as filling the gap between the income you already have (Social Security, pensions, investments) and the extra expenses that come when care is needed.


With the right plan, this “care income” is designed to be tax-free, which means more dollars go directly toward paying for home care, assisted living, or nursing support. It’s not about guessing what care might cost - it’s about creating a dedicated, protected income source so your lifestyle and family finances don’t get derailed. 


When it comes to long-term care, most people plan for average needs and end up with wrong-term care.


Those averages - 2.2 years for men, 3.7 for women - only measure time spent in facilities, not the far longer period of in-home or family care that usually comes first. And as lifespans lengthen, conditions like Alzheimer’s or Parkinson’s can stretch care to 10, 15, even 20 years.


Planning based on averages leads to wrong-term care - underfunded, unprepared, and unsustainable. 


Plan for longevity, not the average.


Yes - Medicare and Medicaid are very different when it comes to long-term care.


Medicare is health insurance for people over 65 (and some younger with disabilities), but it only covers short-term, medically necessary care - like rehab after a hospital stay. It does not pay for most long-term custodial care, such as help with bathing, dressing, or living in an assisted living facility. 


Medicaid, on the other hand, is a government program for people with very limited income and assets. It can cover long-term care in a nursing home and, in some cases, at home - but only after you’ve spent down most of your savings to qualify. 


In short, Medicare won’t cover the type of long-term care most families need, and Medicaid is only available once you’ve depleted your resources. 


Short answer: Yesterday. 


But seriously - any age between 35 and 87 is valid. You’ll never be younger or healthier than right now. Accidents, strokes, cancer, and yes - even early-onset Alzheimer’s - don’t wait for your 70s.


  • Most experts recommend getting your long-term care plan started in your 40s or 50s - that’s when health is still strong and you can lock in lower premiums before things change. Macri & Associates, LLCAALTCI
     
  • However, options are available up through age 87 - you’re never “too old” to get something in place. LTC News
     

Why sooner is smarter:

  • A person turning 65 today has nearly a 70% chance of needing long-term care later on.National Council on Aging
     
  • And here's a kicker: early-onset dementia is on the rise. Alzheimer’s and similar conditions in people under 65 - sometimes even in their 30s and 40s - are being diagnosed at noticeably higher rates. Blue Cross Blue Shield AssociationMassachusetts General Hospital
     

Bottom line: Starting your plan anywhere between age 35 and 87 gives you choices, control, and peace of mind. Because let’s be real - nobody wakes up hoping they’ll be too young someday.


It’s natural to think your spouse or children will step in if you ever need care. And while love makes that possible, it often comes with a heavy cost - physically, emotionally, and financially.


When a spouse becomes the caregiver, they are often older themselves. Lifting, bathing, and providing daily help can quickly wear them down, sometimes leaving them in worse health than the person receiving care. Emotionally, the strain of being both partner and caregiver is exhausting and can take a serious toll on the relationship.


When adult children step in, the impact is different but just as profound. Many find themselves scaling back at work, missing promotions, or even leaving their jobs entirely. That choice doesn’t just affect today’s paycheck - it weakens their long-term retirement savings, Social Security, and career trajectory. It can also strain their marriages and their ability to raise their own children. 


In other words, the “cost” of family caregiving is more than just hours - it’s years of financial and emotional sacrifice.


A care income plan doesn’t replace your family’s love; it protects it. Even if your spouse or children want to help, having tax-free dollars set aside gives you and them choices. It allows you to bring in professionals for the heavy lifting, hire respite care so family can rest or take a vacation, or pay for supportive equipment to make home care easier and safer. 


The point isn’t to push family away - it’s to make sure their role is one of oversight and support, not exhaustion and sacrifice.


With a plan in place, your family can stay your family - not your full-time caregivers.


It’s not really a matter of “should you” - it’s a matter of “why would you?” 


Even if you have millions, most wealthy people don’t like spending their own money when there’s a smarter way. They understand leverage: using other people’s money to make their pennies work like dollars. That’s exactly what a long-term care income plan does.


Self-funding care usually means selling assets or investments - often in a down market - which can trigger a taxable event. Suddenly that $100,000 care bill might require you to pull out $140,000 or more after federal, state, and local taxes. 


On top of that, the extra income can push you into a higher tax bracket and even increase your Medicare premiums due to IRMAA surcharges. That’s a ripple effect most people don’t see coming until it’s too late.


With a dedicated long-term care income plan, you create a tax-efficient stream of money that’s there when you need it - without destabilizing your portfolio or burdening your family.  It keeps the plan in tact the way it was set up to be.


It’s not about whether you can self-fund. It’s about why you’d choose to, when there’s a more tax efficient and leveraged way to pay.


Many financial advisors are unaware of the ripple effect of self-funding.


Traditional long-term care insurance is like health insurance - you pay ongoing premiums, and if you need care, the policy helps cover the costs. But if you never need care, you don’t get anything back, which can make it feel like “use it or lose it.” 


Asset-based or hybrid long-term care insurance works differently. It combines life insurance or an annuity with long-term care benefits. That means if you need care, it pays for it; if you don’t, the money can go to your family as a death benefit or stay as part of your cash value. In other words, you get protection either way - coverage if care is needed, or value returned if it’s not. 


 Both types of long-term care insurance can provide valuable protection, but they work differently - and it’s important to know what you’re signing up for.


  • Cash Indemnity: Once you qualify for benefits, the insurance company sends you a set monthly amount in cash, no receipts required to the insurance company. This may give you flexibility - you can pay a facility, hire caregivers directly, or even pay a family member. But here’s the catch: the IRS considers money paid to a family member as household employee wages. That can mean tax forms, payroll rules, and the need to track things carefully. You also need to keep receipts and documentation in case the IRS ever asks, even though the insurance company doesn’t require them.  
    • When you receive cash benefits, any amount above the IRS per-diem limit could be taxable unless you can show receipts proving the money was spent on legitimate long-term care expenses.
       
  • Reimbursement: With this option, the insurance company reimburses you for actual care expenses - but you must submit bills and receipts. Often times the insurance company receives the bills directly from the care provider.  One less thing your family will have to deal with.  It’s more structured, but, you don’t run into potential tax issues or requiring extra tax forms.
     

Neither option is bad - it depends on what matters more: flexibility with more responsibility (cash indemnity), or structure with less risk of tax complications (reimbursement). 


The real key is making sure your family understands the rules of whichever you choose. Without guidance, loved ones can easily become confused or frustrated in the middle of an already stressful situation. That’s why working with me is so important: I help families set up the right plan, and I stay with them to make sure the benefits are used correctly when the time comes.


That’s a tough question - tell me exactly how long you’ll live, and I'll tell you how much you'll need. 


The fact is, none of us knows. If you base your coverage strictly on the “averages,” you may be planning for wrong-term care, not long-term care.


The best policy is the one that lasts as long as you do. That’s why many people - especially couples on a joint policy - choose lifetime or unlimited benefits. It ensures that no matter what happens, both spouses are covered forever. You don't have to worry about one burning through it all and leaving the surviving spouse with little to nothing.  That kind of protection brings peace of mind, knowing there won’t be financial surprises down the road.


That being said, if you’re on a budget, remember this: something is always better than nothing. 


Just like if you’re hungry, half a sandwich is better than no sandwich at all. Some policies offer only a couple of years of benefits, some 4-8 years, and some offer lifetime coverage. Even partial coverage can ease the burden on your family and preserve your savings.


Bottom line - get what you can, and when possible, aim for protection that lasts as long as you do.


Maybe! 


Having health conditions doesn’t automatically disqualify you from getting long-term care coverage. This is where working with an expert really makes the difference.


After 27 years on the corporate insurance side, I know how underwriting works, what carriers are looking for, and which companies are more likely to approve certain conditions. I can’t make promises, but I often have a higher success rate simply because I know where to look and how to position an application.


Many people with past cancers, heart conditions, or even well-controlled diabetes can still qualify. It depends on key factors such as how long ago the diagnosis was, how it was treated, and how you’re doing now. 


Insurance companies also want to see that you are proactive about your health - that you see your doctor regularly and stay up to date with check-ups.


That said, if you’ve been recommended for surgery and haven’t had it yet, are currently in therapy, or are waiting for a doctor’s clearance, most insurers will postpone approval until you’ve recovered and have the all-clear.


The good news? Even with health conditions, there are often options available. Having someone who understands the underwriting landscape gives you the best chance at finding coverage that works for you.


To start receiving benefits, two conditions must usually be met under both federally tax-qualified long-term care insurance policies (like those that follow IRS rules) and most state-regulated plans:

  1. You must be unable to perform at least two of the six Activities of Daily Living (ADLs), such as:
    • Dressing
    • Bathing
    • Toileting 
    • Transferring (moving in/out of bed or chair) 
    • Eating
    • Continence
      -- Source: ADL definitions and the two-ADL rule erisaattorneys.com

ACL Administration for Community Living Wikipedia
 

  1. Or you must have a severe cognitive impairment, meaning a serious decline in mental capacity requiring substantial supervision to protect your health or safety - think advanced Alzheimer’s, dementia, or brain injury. This is also a valid benefit trigger. erisaattorneys.com
     

These aren't arbitrary guidelines - they’re federal standards tied to the tax-qualified status of LTC policies under Internal Revenue Code Section 7702B. Policies must follow these definitions to qualify for tax-advantaged treatment. Wikipedia+1


  • Your primary care physician or a licensed healthcare practitioner must certify that you meet one of the triggers - either the inability to perform two ADLs or severe cognitive impairment.
     

Why this matters:

  • These rules ensure fairness and consistency across insurers - and protect your tax benefits.
     
  • Getting the right documentation up front can mean the difference between fast access to benefits and frustrating delays.
     

In plain English: Once your doctor certifies that you really can’t do at least two of life's basics - or your cognitive health has declined enough to need constant supervision - you’ve met the “benefits on” switch. Then it’s about submitting the paperwork, fulfilling any waiting period, and getting that Plan of Care in motion.


The good news is - you’re not locked into just paying monthly or annual premiums. There are multiple ways to fund a long-term care income plan, and many people use money they’ve already set aside:


  • Retirement Accounts (IRA or 401(k)): You can reposition qualified money into a plan that not only provides long-term care benefits but can also cover your spouse. This turns part of your retirement nest egg into a tax-efficient safety net.
     
  • Annuities: If you bought an annuity years ago, the interest growth inside it is normally taxable when withdrawn. Thanks to the Pension Protection Act (PPA), you can reposition that annuity and make the taxable growth completely tax-free when it’s used for long-term care.
     
  • Cash Savings or CDs: If you have savings, CDs, or “lazy money” you weren’t planning to use for everyday income, you can put those funds to work by repositioning them into a care plan that leverages every dollar.
     
  • Cash Value Life Insurance: If you own a life insurance policy you no longer need, you can reposition its cash value to create tax-free care income, putting those dollars to better use while still protecting your family.
     

In short, you don’t have to come up with new money to pay for long-term care. Often, it’s about repositioning existing assets you’ve already built - turning them into a more powerful tool that protects you, your spouse, and your family.


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