When Should You Start Planning for Long-Term Care?

Most people do not think about long-term care until a parent or spouse needs it — and by then, it is often too late to plan effectively. The truth is that the best time to start planning for long-term care was yesterday, and the second-best time is today. This guide explains why timing matters so much, what the ideal planning window looks like, and what options remain if you are getting a late start.

Why Most People Wait Too Long

Long-term care is one of the most significant financial risks in retirement, yet it is also one of the most commonly ignored. Research consistently shows that the majority of Americans have done little to no planning for potential long-term care needs.

The reasons people delay are understandable but dangerous:

• Denial: “It will not happen to me.” The reality is that approximately 70% of people who reach age 65 will need some form of long-term care.
• Confusion: Many people assume Medicare will cover long-term care. It does not cover custodial care, which is what most people actually need.
• Cost avoidance: Long-term care insurance premiums feel expensive — until you compare them to the cost of care itself.
• Procrastination: “I will deal with it later.” But later comes with higher premiums, worse health, and higher denial rates.
• Complexity: The LTC insurance market can feel overwhelming, with different policy types, benefit structures, and carriers to compare.

The consequence of waiting is severe. Every year you delay, your options narrow, your costs increase, and your risk of being unable to qualify for coverage grows. Let us look at the specific numbers.

The Ideal Age to Start Planning: Your 50s

Financial advisors and insurance professionals generally agree that the ideal age to begin long-term care planning is between 50 and 60. Here is why this window is optimal:

Health Qualification

Long-term care insurance requires medical underwriting. Unlike life insurance, where you can sometimes get coverage with health issues through guaranteed-issue policies, LTC insurance underwriting is strict. Conditions like diabetes, heart disease, neurological disorders, and even being on certain medications can disqualify you. In your 50s, you are most likely to be healthy enough to qualify.

Premium Affordability

Premiums are directly tied to the age at which you purchase the policy. The younger and healthier you are when you buy, the lower your premiums will be — and you will lock in that rate for the life of the policy (though carriers can apply for across-the-board rate increases).

As this table illustrates, waiting from age 55 to age 65 can nearly double or triple your annual premium. And the total premiums paid by age 85 can be significantly higher despite having fewer years of coverage.

LTC Insurance Denial Rates by Age

One of the most compelling reasons to plan early is the dramatic increase in denial rates as you age. Long-term care insurance underwriting is more stringent than most other types of insurance, and the older you are, the more likely you are to have health conditions that disqualify you.

These numbers are sobering. If you wait until your 70s to apply for traditional long-term care insurance, there is roughly a one-in-two chance you will be denied. At that point, your options become severely limited and significantly more expensive.

Common Disqualifying Conditions

The following conditions typically result in automatic denial for traditional LTC insurance:

• Alzheimer’s disease, dementia, or mild cognitive impairment
• Parkinson’s disease or multiple sclerosis
• Current need for assistance with activities of daily living
• Recent stroke (within the past 2–3 years)
• Insulin-dependent diabetes with complications
• Use of a walker, wheelchair, or motorized scooter
• Current residence in an assisted living facility or nursing home

Many conditions that are manageable in your 50s — such as controlled high blood pressure or well-managed type 2 diabetes — become disqualifying as they progress or develop complications. This is why applying while your health conditions are still mild and controlled dramatically improves your chances of approval.

Your Long-Term Care Planning Timeline

Long-term care planning is not a single event — it is a process that unfolds over years. Here is a recommended timeline based on your age:

Ages 45–50: Awareness and Education

• Learn about the different types of long-term care (nursing home, assisted living, home care)
• Understand that Medicare does not cover custodial care
• Start conversations with your spouse or partner about preferences and values
• Observe older family members’ care needs to understand your potential risk
• Get a baseline understanding of costs in your area (see: Long-Term Care Costs in North Carolina)

Ages 50–55: Research and Comparison

• Research the different types of LTC coverage: traditional LTC insurance, hybrid policies, and self-insurance strategies
• Get preliminary quotes from multiple carriers
• Evaluate your health status honestly — if you have any emerging conditions, sooner is better than later
• Meet with a financial advisor to incorporate LTC planning into your overall retirement strategy
• Consider how your existing assets, Social Security, and pension would factor into care funding

Ages 55–60: Application and Purchase

• Apply for long-term care insurance (traditional or hybrid) while you are still likely to qualify
• Complete the medical underwriting process, which typically includes a health questionnaire, phone interview, and sometimes a brief in-person assessment
• Select your benefit amount, benefit period, and elimination period based on your financial situation
• Establish advance directives and powers of attorney alongside your LTC insurance purchase
• Discuss your plan with your adult children so they understand your wishes and coverage

Ages 60–65: Last Chance Window

• If you have not purchased LTC insurance yet, this is your last realistic window for traditional coverage at reasonable rates
• Hybrid life insurance/LTC policies may offer more flexible underwriting at this stage
• Consider accelerating savings in dedicated accounts for potential care costs
• Review any existing policies to ensure benefits and inflation protection are adequate

Ages 65+: Alternative Strategies

• If traditional LTC insurance is no longer available or affordable, explore hybrid policies, annuity-based LTC riders, and self-insurance strategies
• Consult with an elder law attorney about Medicaid planning (keeping the 5-year look-back period in mind)
• Ensure your estate documents (will, trust, power of attorney, healthcare proxy) are up to date

Options at Every Age

No matter your current age, there are strategies you can pursue. Here is what is available at different life stages:

In Your 40s: The Early Bird Advantage

While most 40-somethings are not thinking about long-term care, buying coverage now locks in the lowest possible premiums. If you have a family history of Alzheimer’s, Parkinson’s, or other conditions that could affect your future insurability, applying in your 40s is a smart move. Hybrid life insurance/LTC policies are particularly attractive at this age because you are essentially buying life insurance you need anyway with an LTC rider that adds negligible cost.

In Your 50s: The Sweet Spot

This is the optimal window for most people. You have enough life experience and financial stability to make informed decisions, premiums are still affordable, and your health is likely good enough to qualify. Both traditional LTC insurance and hybrid policies are strong options at this age.

In Your 60s: Still Feasible, But Act Fast

Traditional LTC insurance is still available in your 60s, but premiums are significantly higher and denial rates climb. Hybrid policies (which combine life insurance with LTC benefits) often have more lenient underwriting and may be a better option. Some people in their 60s choose a combination approach: a smaller LTC policy supplemented by dedicated savings.

In Your 70s and Beyond: Limited But Not Hopeless

Traditional LTC insurance is very difficult to obtain after 70, and premiums are prohibitive for most people. At this stage, your options include:

• Hybrid policies with simplified underwriting: Some carriers offer guaranteed-issue or simplified-issue hybrid products for older applicants
• Short-term care insurance: Policies that cover 6 to 12 months of care with less stringent underwriting
• Self-insurance: Setting aside dedicated funds (ideally $200,000+) specifically for potential care needs
• Medicaid planning: Working with an elder law attorney to structure assets within Medicaid guidelines (planning must begin at least 5 years before you might need care)
• Life insurance conversion: Some life insurance policies can be converted to long-term care benefits through life settlements or accelerated benefit riders
• VA benefits: If you are a veteran, explore Aid and Attendance and other VA long-term care benefits

What Happens If You Need Care Without a Plan

Understanding the worst-case scenario can be a powerful motivator. Here is what typically happens when someone needs long-term care without any coverage or advance planning:

Step 1: Family Scrambles

An unexpected health event — a stroke, a fall, a dementia diagnosis — throws the family into crisis mode. Adult children suddenly become caregivers while trying to manage their own careers and families. Decisions about care settings, costs, and logistics are made under extreme stress with little preparation.

Step 2: Savings Drain Rapidly

Without insurance, care costs come directly from savings. At $8,500 per month for a nursing home in North Carolina, a $500,000 retirement nest egg would be depleted in less than 5 years — leaving nothing for the surviving spouse’s retirement or the family’s inheritance.

Step 3: Family Caregivers Burn Out

To reduce costs, family members often take on caregiving responsibilities. But caregiving is physically and emotionally exhausting. Studies show that family caregivers experience higher rates of depression, anxiety, and their own health problems. Many reduce their work hours or leave their jobs entirely, sacrificing their own financial security.

Step 4: Medicaid Spend-Down

When savings run out, the individual must “spend down” to Medicaid eligibility levels (roughly $2,000 in countable assets in North Carolina). This often means selling the family home, liquidating investments, and essentially becoming impoverished to qualify for government assistance. Medicaid coverage is available, but the choice of facilities may be limited.

Step 5: Surviving Spouse at Risk

If one spouse needs expensive long-term care, the surviving spouse may be left with severely depleted resources. While Medicaid has some spousal impoverishment protections, the remaining spouse’s financial security can still be significantly compromised.

The Cost of Inaction vs. The Cost of Planning

Even in a worst-case scenario where you pay LTC insurance premiums for 30 years and never need care, the total premiums are a fraction of what a single long-term care event would cost out of pocket. And with hybrid policies, you do not lose your investment even if you never need care.

Frequently Asked Questions