Many seniors have misconceptions on the differences between Medicare and Medicaid eligibility benefits.
Throw in long term care insurance, and the water gets even more muddier. Even as a Certified Financial Planner, it’s tough trying to stay on top of all the issues concerning seniors.
To help clear some of the mental fog that comes along with these issues, I decided to bring in a subject matter expert to help out. Tiffanny Sievers, Attorney at Law and founder of SI Elder Law has been kind of enough to share her expertise on the differences between Medicare and Medicaid and how seniors can plan for their later years. Here’s what she had to say….
1. What steps can one make to prepare for dealing with elder issues?
In order to properly prepare for elder issues a individual first needs to have a good foundation of good planning documents. This means having a Power of Attorney for Property and a Power of Attorney for Health Care. These documents allow someone you pick to make property and health care decisions for you when you are unable to do so yourself. Second they need to be prepared for an untimely death. It is better to plan when you are healthy than when you are sick.
Of course, meet with an attorney and that attorney can help you decide what documents you will need to make sure that your wishes are carried out after your death, such as a last will and testament or trust. Third, meet with your financial advisor to determine what investments will give your beneficiaries the best tax benefits and make sure that you have enough Life Insurance to pay for your burial expenses.
Finally, you need to make sure that you have enough assets to avoid running out of money. Once you run out of money, you run out of options. One needs to meet with an elder law attorney, like myself, to make sure that your assets are properly placed to avoid running out of money if you need long term care either at home or in a nursing home.
2. How long will Medicare cover nursing home costs?
In a nursing home, Medicare will cover the first 20 days 100% and then the next 80 days at 80% if you continue to improve medically. After the first 100 days no matter how much improvement you make, Medicare will stop paying and you must either move out or find some other way to pay.
3. What is the difference between Medicare and Medicaid? Common misconceptions?
Medicaid
Almost everyone over the age of 65 is on Medicare and it doesn’t matter what your assets are. However, you must qualify for Medicaid, Medically and financially. Medicaid will only pay if you have limited assets. This means that after Medicare stops paying you have to spend down your assets until you are just about broke before you qualify for Medicaid.
4. How much does it cost to be in nursing home?
Nursing homes in Southern Illinois cost between $2200 and $5500 a month. In Chicago, one month is $7,500 and up. Assisted Living Ranges from $1,500 to $4,500 a month. Private caregivers in your home range between $3000 and $12,000 a month depending on how much care is needed.
5. What are the ways to pay for nursing home costs?
In my opinion, there are five ways to pay for nursing home costs:
1. Private Pay – with good old fashion cash. 2. Long Term Care Insurance – If you have bought “nursing home insurance” the policy will pay a certain amount of money per day for your stay in a nursing facility. You must have bought a policy before you needed nursing home care. 3. Veterans Benefits – The Veterans Administration offers a VA Pension benefits for Veterans or Widows of Veterans if you meet three criteria:
1. Served at least 90 days of active duty
2. One of those days was during a period of war
3. Were something other than dishonorably discharged from the military.
4. Medicare – as discussed above will only pay for part of the first 100 day stay in a Skilled Care Facility 5. Medicaid – Medicaid pays for your entire stay at a nursing home or supportive living facility. It does not pay for care at home.
Medicaid, unlike Veterans benefits, does not pay a cash benefit but only pays directly for services. In fact, you will never receive any cash from Medicaid. Medicaid has no limit, it will pay for any kind of care that you need. For example, Medicaid will pay for the removal of a splinter or for open heart surgery, no matter the cost.
In order to qualify for Medicaid there are asset and income limitations. If you are married, the community spouse cannot have more than $109, 560 plus a house in assets. If you are married, the community spouse will get to keep about $2700 a month of the couple’s combined income. Whatever income the couple has over the $2700 the nursing home will be awarded.
If you are single, you must have less than $2000 in assets and all of your income will go to the nursing home less $30 a month. What SI Elder Law does, is help protect assets so that you can be on Medicaid and not be completely broke. In most cases, SI Elder Law can save half of your assets once you are in a nursing home and you will receive Medicaid benefits. The sooner that you call SI Elder Law the more money that we can save.
6. What hope, if any, is there for those that didn’t plan?
With the current laws right now in Illinois, if you haven’t done any planning and are already in a nursing home, I can save half of your assets. The sooner you get to me the more money that I can protect. For some of my clients, I am able to protect everything.
7. Anything else?
Remember, that any transfer of assets, if not done the correct way can give you a big penalty period and that might have been avoidable. It is best to talk with an Elder Law attorney before moving any assets so that you get the shortest penalty period possible or avoid a penalty period at all.
If anyone is already facing the possibility of nursing home care, I offer a free consultation in my office to see if there is anything that I can do to help.
Paying for a nursing home can seriously deplete your retirement savings. The government-funded Medicaid program can pay some or all nursing home costs, but it’s restricted to people of very limited financial means. You may be able to qualify for government assistance with nursing home costs, even if you control substantial wealth if you transfer nearly all your assets into an irrevocable trust. An irrevocable trust can protect your money from nursing home costs, but they have costs and drawbacks of their own, including permanently losing direct control of your assets. Talk to a financial advisor to learn about options for paying for long-term care.
Irrevocable Trust Basics
A trust is a legal entity many people create as part of an estate plan. The trust acts as a container for assets transferred into it by the grantor. A trustee is appointed to manage the assets in the trust for the benefit of one or more beneficiaries.
A trust can be revocable or irrevocable. You can make changes to a revocable trust after establishing it, including removing assets from the trust. Irrevocable trusts, however, cannot be changed after establishment. That means transferring assets to the trust is a one-way process. Once in, assets cannot be removed from an irrevocable trust.
Irrevocable Medicaid Trusts
Irrevocable trusts come in several varieties and can help with many different estate planning and other personal finance tasks. Medicaid trusts are the kind used to help reduce the impact of nursing home costs.
More specifically, Medicaid trusts are designed to help people qualify for Medicaid, the government health insurance program. Unlike Medicare, which is not means-tested, Medicaid is only available to people of limited financial means.
The program is administered by states, which determine their own Medicaid eligibility requirements in a variety of ways. In most, the annual income limit is $29,160 or less. This cap includes Social Security and pension benefits as well as wages and investment income. Financial resources such as bank accounts, investments, revocable trusts and real estate typically can’t total more than $2,000. People who have more income and more assets may have to spend their own assets to pay for nursing home care until their assets have declined to the point they meet the Medicaid caps.
An irrevocable Medicaid trust is designed to help someone qualify for Medicaid without having to deplete their own assets. After creating the trust, they can transfer in enough assets to bring them below Medicaid’s caps. Once they have done that, assuming they have followed the rules, Medicaid will pay some or all of their nursing home costs. In this way, an irrevocable trust can protect assets from nursing home costs.
Keep in mind that some people say it’s unethical to use trusts to shield your assets from Medicaid. Others believe it’s perfectly fine, considering the rules and laws set up around Medicaid. Ultimately, whether you use an irrevocable trust to protect your assets from nursing home costs will be based on your financial situation, as well as your thoughts and feelings on the ethics.
Limits of Irrevocable Trusts
Irrevocable trusts have a number of limitations that anyone planning to use one will want to keep in mind. These include:
One-way transfer. Assets placed in the trust can’t be taken out of the trust for as long as the grantor of the trust is alive.
Five-year limit. Assets must be transferred into the trust at least five years before the grantor seeks to acquire Medicaid eligibility. Irrevocable trusts can’t help at the last minute.
Medicaid doesn’t always pay all costs. A Medicaid patient in a nursing home still has to use their own income to pay for most nursing home costs. Medicaid will often pay for most and sometimes all of the costs, but patients usually shoulder some of the financial burden.
Not all nursing homes qualify. Medicaid only pays for care in certain approved nursing homes.
Other Ways to Protect Assets from Nursing Home Costs
An irrevocable trust is not the only tool available to help with nursing home costs. Here are some of the alternatives:
Long-term care insurance can cover some or all nursing home costs without having to consider Medicaid eligibility.
Medicaid-compliant annuities can be used to generate income that isn’t included in Medicaid’s income assessment.
A life estate transfers ownership of assets in your estate to a spouse, removing them from consideration when determining Medicaid eligibility.
Financial gifts to family members can reduce your net worth enough to meet Medicaid’s guidelines.
Bottom Line
An irrevocable trust can help you avoid having to use your own assets to pay for nursing home care by making you eligible for Medicaid. Medicaid can pay some or all of your costs, but only if you meet strict financial guidelines for income and assets. Transferring assets into an irrevocable trust, called a Medicaid trust, can help even people with significant assets meet these guidelines, But once assets are transferred to an irrevocable trust, they can’t be retrieved from the trust.
Tips for Long-Term Care Planning
A financial advisor can help you design a strategy for covering long-term care costs using an irrevocable trust, if appropriate, as well as other methods. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
Whether you are retired or still working, keeping a budget is a basic tool to help you for prepare for future needs such as paying for a nursing home. SmartAsset’s Budget Calculator can tell you how your spending stacks up to other people in your area.
If you thinking about purchasing long-term care insurance, be sure to review our picks for the top long-term care insurance providers of 2023.
Mark Henricks
Mark Henricks has reported on personal finance, investing, retirement, entrepreneurship and other topics for more than 30 years. His freelance byline has appeared on CNBC.com and in The Wall Street Journal, The New York Times, The Washington Post, Kiplinger’s Personal Finance and other leading publications. Mark has written books including, “Not Just A Living: The Complete Guide to Creating a Business That Gives You A Life.” His favorite reporting is the kind that helps ordinary people increase their personal wealth and life satisfaction. A graduate of the University of Texas journalism program, he lives in Austin, Texas. In his spare time he enjoys reading, volunteering, performing in an acoustic music duo, whitewater kayaking, wilderness backpacking and competing in triathlons.
Did you know that the average American has a nearly 70% chance of needing some form of long-term care upon reaching age 65? But did you also know that you may be able to prepare for the event by purchasing long-term care insurance? That’s why we’ve prepared this guide of the 7 best long-term care insurance of 2023.
Before getting into our reviews of the seven best long-term care insurance providers of 2023, scan the table below to see which company you think will work best for you:
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Our Picks for Best Long-Term Care Insurance
Dozens of insurance companies offer long-term care insurance, but below is our list of the top seven, and what each is best for:
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Best Long-Term Care Insurance – Company Reviews
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Maximum Benefits: Varies by provider
Benefit Period: Varies by provider
Waiting/Elimination Period: Varies by provider
GoldenCare, also known as National Independent Brokers, Inc, is a privately held long-term care insurance brokerage firm, and one of the leading such firms in the industry. They provide policies from the top-rated insurance companies in the industry. The company is based in Plymouth, Minnesota, and has been in business since 1976. Their plans are available in all 50 states.
The list of companies they work with includes the following:
GoldenCare also offers critical illness insurance, Medicare supplements and Medicare Advantage plans, prescription drug plans, life insurance, annuities and final expense policies.
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Maximum Benefits: Varies by provider
Benefit Period: Varies by provider
Waiting/Elimination Period: Varies by provider
Like GoldenCare, LTC Resource Centers is also an insurance brokerage specializing in long-term care insurance. Based in Cape Coral, Florida, the company has been in business for more than 40 years. They provide long-term care insurance, short-term care, linked or combination products, Medicare supplements, life insurance, critical illness, and annuities.
A specialization they offer is what is known as asset-based long-term care. It’s a strategy that uses a whole life insurance policy or annuity to provide long-term care coverage, which eliminates the need for an expensive, dedicated LTC policy. A pricing comparison is presented in the screenshot below:
As a broker, they work with multiple long-term care insurance providers. That means to get detailed information you’ll need to set an appointment with a long-term care insurance specialist and make the request. The company’s licensed to operate in all 50 states.
Maximum Benefits: Up to $400 per day or $10,000 per month
Benefit Period: Up to 5 years, or unlimited lifetime benefit
Waiting/Elimination Period: 0, 30, 60, 90, 180 or 365 days
Mutual of Omaha is one of the top individual providers of long-term care insurance. They offer some of the best plans in the industry, including lifetime benefits coverage, multiple elimination periods, and inflation protection. They are a full-service insurance company providing coverage in all 50 states, providing virtually all types of insurance policies.
Mutual of Omaha also offers premium discounts. For example, you can save 15% when you purchase a policy for both you and your partner. You can also save 15% if you’re in good health. There’s even a 5% discount if you are married but your spouse does not purchase a policy.
Maximum Benefits: Up to $7,000 per day, up to a $250,000 lifetime maximum
Benefit Period: Up to maximum daily or lifetime limit
Waiting/Elimination Period: One-time deductible of $4,500 up to $21,000
Like Mutual of Omaha, New York Life is a large, well-established and diversified insurance company. In addition to long-term care policies, they also offer virtually every other type of insurance policy available. Also like Mutual of Omaha, New York Life is a mutual insurance company, which means it’s owned by its policyholders, not shareholders. The company partnered with the American Association of Retired Persons as a preferred provider of long-term care insurance policies.
New York Life provides their NYL My Care long-term care policy. The basic parameters are as follows:
Like other direct insurance providers on this list, New York Life also offers annuities and whole-life insurance policies with long-term care riders.
Maximum Benefits: Up to $750,000 maximum lifetime benefit
Benefit Period: Up to 7 years
Waiting/Elimination Period: 90 days
Nationwide is one of the leading providers of long-term care insurance in America. With a maximum lifetime benefit of up to $750,000, they provide the highest lifetime maximum benefit on our list. They also offer a single, simple, 90 calendar-day elimination period. You can choose between two years and seven years for a maximum benefit period.
The policy will also cover home healthcare, hospice, adult day care, household services, home safety improvements, and even family care. And in a unique twist, nationwide also provides international benefits. If you live out of the country during the benefit period, the policy will pay 50% of the maximum monthly benefit.
Maximum Benefits: Up to $250,000 maximum lifetime benefit
Benefit Period: Up to maximum lifetime benefit limit
Waiting/Elimination Period: 90 days
Brighthouse Financial is an insurance provider that offers two types of products, annuities and life insurance. Either is available with a long-term care rider. The company has $254 billion in assets, serving about 2 million customers.
Brighthouse Financial provides long-term care insurance through its SmartCare plan. It’s a combination plan that adds a long-term care provision to a whole life insurance policy. You’ll get the benefit of long-term care if it’s needed, but you’ll also have a life insurance benefit to pay to your beneficiaries if it’s not, or if there are any funds left over after your long-term-care stay.
The policy will cover adult day care, hospice, and home healthcare, in addition to nursing homes and assisted living facilities, and skilled nursing care.
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Maximum Benefits: Varies by provider
Benefit Period: Varies by provider
Waiting/Elimination Period: Varies by provider
CLTC Insurance Services, or California Long Term Care Insurance Services, is a long-term care insurance aggregator, based in San Francisco. Aggregator is a fancy word for an online insurance marketplace. As an aggregator, CLTC will give you access to a large number of long-term care insurance companies. You can then choose the one offering the plan that will work best for you. The main limitation of this provider is that they offer policies only in the state of California.
In addition to long-term care insurance, they also offer annuities and life insurance policies, both with long-term care riders. These types of policies eliminate the need for a dedicated LTC policy, since the cost of long-term care is paid out of the proceeds of the annuity or life insurance. CLTC also offers critical illness insurance.
Long-Term Care Insurance Guide
What is Long-Term Care?
When an individual reaches a point where they can no longer care for themselves, long-term care becomes necessary. That care can be provided by anyone from family members to nursing homes.
The need for long-term care generally applies when the individual can no longer perform one or more of the six activities of daily living (ADL). This can include inability to dress, groom, go to the bathroom, bathe, eat, or even to move about freely.
In most cases, long-term care becomes necessary after a major health event, like a heart attack or stroke. But it can also be the result of an ongoing, degenerative health condition or simply advancing age.
In most cases, long-term care is provided by a family member. But institutional care may be necessary if the individual is unable to perform several ADLs, which may overwhelm the ability of family members to provide ongoing care.
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How to Purchase Long-Term Care Coverage?
We recommend contacting any of the seven best long-term care insurance providers in this guide. Otherwise, do a search and identify insurance companies that offer long-term care coverage. But be aware that not all insurance companies offer it, precisely because of the many variables. It involves.
When purchasing a policy, be aware of the following:
Like life insurance, it’s best to purchase LTC insurance when you’re young and healthy. That’s when the premiums are lowest.
Consider purchasing a long-term care insurance alternative, like a life insurance policy or an annuity with a long-term care rider (see below). It’s generally much less expensive.
Pay close attention to the maximum benefit paid, whether daily, monthly, annually, or lifetime. It should approximate nursing home costs in your area. (Be aware that these costs vary greatly from one state to another.)
Pay close attention to the benefit period. While the typical number of years an individual needs long-term care coverage is three years, there’s no way to tell what you may need. If you can afford the higher premium, it may be best to go with the longer benefit period, say, five years or longer.
Be aware of the elimination period. The standard is 90 days, but it can be as long as one year. This is not a minor factor, since nursing home care at $8,000 per month could cost you $24,000 with a 90-day waiting period before benefits kick in. The waiting period you choose should match the amount of liquid assets you expect to have available to cover it.
When you take a policy, be prepared to pay the premium for the rest of your life. If you take a policy at 60, stop making the payments at 80, then you need long-term care at 85, you’ll get no benefits from the lapsed policy.
According to the website Consumer Affairs, long-term care insurance premiums look something like this:
Now, the screenshot above reflects only sample averages for very specific policies at ages 55 and 65. The actual premium you will pay will be based on a combination of factors, including your age at the time of purchase, any health conditions you have, as well as the dollar amount and term of the benefits your policy will include.
Finally, given how complicated long-term care insurance is, it wouldn’t be overkill to have the policy reviewed by an attorney before accepting it. If so, an attorney who specializes in elder care will be your best choice.
Who Needs Long-Term Care Coverage?
The short answer to this question is everyone. The unfortunate reality is that people turning 65 have an almost 70% chance of needing some type of long-term care services during their lifetimes. Approximately 37% will require institutional care. And statistically, women and single individuals are more likely to require long-term care than men and married individuals.
If you’re unsure if you need long-term care, check out Jeff’s post, Long term care insurance: do you really need it?.
Though it isn’t well-known outside the industry, there are two basic types of long-term care coverage available. The first is a standalone long-term-care insurance policy.
Like a life insurance policy, medical underwriting will be performed. The insurance company will consider your age, your health condition, your family health history, your occupation, requested benefit levels, and other factors in approving your application and setting the premium level. This is the more costly of the two options.
The other is a hybrid policy. Most commonly, this is life insurance with long-term care benefits. You’ll purchase a basic life insurance policy, then add a long-term care rider to the policy. This will increase the premium on the life insurance policy, but it will be much less expensive than a standalone long-term-care policy.
Meanwhile, you’ll also have a death benefit from the life insurance policy, in addition to long-term-care coverage. But the policy may also include using some or all the death benefits to pay the long-term-care benefits. Your beneficiaries will receive only the amount of the unused death benefit upon your death.
Most of the best life insurance companies offer life insurance policies with this rider.
Another variant of this option is to use an annuity with long-term care rider. Annuities are designed to provide an income stream, very similar to a pension. But similar to a life insurance policy with a long-term care insurance rider, you can also add the rider to an annuity.
Again, it will be less expensive than purchasing a standalone long-term-care policy. And the long-term-care benefits may reduce any death benefit in your annuity. But the provision will be much less expensive than purchasing a standalone long-term-care policy.
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Finding the Right Policy
Long-term care insurance is one of the more complicated insurance types. It also includes more potential variables than other policies. For example, not only will you not know if you will need the coverage at all, but you won’t know when, to what degree, what level of care will be required, or how long it will be needed.
Because of all these variables, the cost of a long-term care insurance policy can be all over the place. But it may be better to pay a little bit more for a more comprehensive policy than to price-shop for the least expensive plan.
Before deciding to purchase a long-term-care insurance policy, first review Jeff’s Podcast episode: Long Term Care Insurance – How much do you need? Given how complicated long-term-care insurance is, it’s best to go in with as much knowledge as possible.
How We Found the Best Long-Term Care Insurance Companies
We used the following criteria to determine the best long-term care insurance companies of 2023:
Maximum Benefits: Given that the cost of long-term care can easily run into hundreds of thousands of dollars, we favored companies with the most generous lifetime benefits.
Benefit Period: One of the most basic problems with long-term care is the uncertainty. There’s no way to know in advance what level of care you might need, or how long it might be necessary. For that reason, we favor the companies that provide the most flexibility in this area.
Waiting/Elimination Period: Just as most insurance policies have deductibles, long-term care insurance uses the waiting period in much the same way. The standard delay on benefits is 90 days. But we prefer companies that offer longer waiting periods, since this will represent an opportunity to lower the cost.
Speaking of cost, as much as we would like to provide a list of average costs per provider, this information simply is not available. That’s because long-term care insurance is highly customized. There’s nothing approximating a “one-size-fits-all” policy, as each policy premium is determined by a multitude of factors.
These include your age at the time you purchase the policy, your general health condition, your family health history, the length and amount of coverage you need, and many other factors. The only way to get a reliable premium figure will be to contact one of the companies above and get a quote.
Best Long Term Care Insurance FAQs
What is long-term care insurance?
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Long-term care insurance is a type of coverage that will provide benefits to pay for your personal care when you’re no longer able to do so for yourself. While the typical long-term-care scenario involves a nursing home, it also applies in lesser situations. That can include assisted living arrangements, home nursing care, and even family care. The policy will begin paying benefits when you qualify for care based on inability to perform several of the ADLs.
What does long-term care insurance cover?
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As mentioned earlier, long-term care insurance benefits begin to apply when you are unable to perform activities of basic living. Depending on the type of policy you have, you’ll receive benefits for a stay in a nursing home, an assisted living facility, skilled nursing care, an adult day care, hospice, and even home care provided by your family.
Some policies will even provide for the cost of modifying your home to better accommodate your capabilities, or the purchase of certain helpful equipment.
How long does long-term care insurance work?
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A typical long-term-care insurance policy will pay benefits between two and five years, though some will go as long as seven, and a few providers offer lifetime benefits. You should be aware that you will need to qualify for whatever coverage term you prefer, and the longer the term, the higher the premium will be.
Is long-term care insurance worth it?
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It really depends on your perceived need for the coverage, and your ability to pay the premiums. Need can be determined by your family history. If you have multiple family members who require long-term care, having the coverage for yourself will be highly desirable. But if you’re in excellent health, and there’s little history of a need for care in your family, you may want to pass on the coverage.
And of course, given the high cost of the premiums, your ability to afford coverage can never be ignored. But if you have very limited financial means, Medicaid may provide benefits for long-term care. However, to qualify your total assets must generally be below $2,000.
Summary of the Best Long-Term Care Insurance Companies
Let’s wrap up this guide by giving you one more look at our list of the seven best long-term care insurance companies of 2023:
Long-term care insurance isn’t inexpensive. But given the unusually high likelihood that will be needed at some point in your life, it’s a policy worth having if you can afford it. And if you can’t, consider taking an annuity or a whole life insurance policy with a long-term care provision.
Many retirees go to nursing homes as their needs increase, creating a dilemma for protecting their wealth. A revocable trust places your wealth in a tax-protected vehicle you can control until you die. But, unfortunately, it wonât protect assets from ⦠Continue reading â
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My family has been fortunate to not have had a family member spend a considerable time in the nursing home. For families who have not been as fortunate, the whole experience can be a devastating one; emotionally and financially. For those who were fortunate enough to have taken out a long term care policy, they […]
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Did you know that the average American has a nearly 70% chance of needing some form of long-term care upon reaching age 65? But did you also know that you may be able to prepare for the event by purchasing long-term care insurance? Thatâs why weâve prepared this guide of the 7 best long-term care […]
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