Caring for the Disabled Elderly: Who Will Pay?

By Alice M. Rivlin; Joshua M. Wiener et al. | Go to book overview

Chapter Four
Private Long-Term Care Insurance

American society widely uses insurance to protect against loss from potentially catastrophic events such as hospitalization, automobile accidents, home fires, theft, and early death.* Insurance against the potentially devastating costs of long-term care, however, is relatively rare. To date, only about 423,000 long-term care insurance policies have been sold. 1 And in 1985 private insurance covered only about 1 percent of total nursing home expenditures. 2

Despite these small numbers, private long-term care insurance is a rapidly changing market. The number of insurance products more than tripled between 1983 and 1987, so that sixty different products were on the market as of mid-1987. 3 Some of the newer products are offering improved benefits. Most of the large insurance companies, including Prudential, Aetna, Travelers, and Metropolitan Life, are now offering policies, at least on an experimental basis. And several government agencies have recently issued reports encouraging long-term care insurance. 4

Although the use of private insurance is likely to spread substantially, none of our simulations suggest that it will become the dominant form of long-term care financing. A reasonably optimistic estimate would be that by 2016-20 a third of the elderly could afford a moderately comprehensive freestanding insurance product. Even in the two simulations with the most generous purchase assumptions, a third or more of the elderly could not afford insurance. Moreover, the effect of

____________________
*
Americans have eagerly bought acute care insurance. Indeed, they have shown such a willingness to buy insurance, rather than to pay even routine medical costs out-of- pocket, that the prevalence of health insurance has become a cause of concern. The pervasiveness of third-party payment for acute care is thought to contribute to an excessive use of care and higher costs.

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