By NextBestFitCatastrophic coverage after a waiting period
Public coverage starts after, e.g., 2 years of need; private insurance or savings cover the first part.
Draft decision:RejectedConfidence: low · not yet reviewed
Full long-term care coverage inside the public plan chosen instead.
To review: Cheaper fallback if the full program is too costly.
Review ledgerHow this path connects
This path
Catastrophic coverage after a waiting period
Creates or worsens
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Create public LTC coverage after a waiting period
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Long-term care requires spending down to poverty
Public coverage after a waiting period protects against financial ruin at lower cost and encourages private insurance for the early period of care. Families still pay the initial costs.
What it creates or worsens
- Solves only part of the problem
Coverage after a waiting period relies on private insurance or savings for initial care, but the private long-term care insurance market is weak.
Who's affected
Who gains
- Older adults
- Long-term care requires spending down to poverty: Coverage rules require exhausting savings and leave people waiting for home care.
- Older and disabled people needing long-term care
- Long-term care requires spending down to poverty: Coverage rules require exhausting savings and leave people waiting for home care.
- Family caregivers and affected families
- Long-term care requires spending down to poverty: Home-care waiting lists leave families providing care.
Who loses
- Hospitals, clinics, and care organizations
- Long-term care requires spending down to poverty: Institutional coverage bias benefits nursing-home operators.
- Elder-law planners
- Long-term care requires spending down to poverty: Spend-down rules create demand for elder-law planning.
- Taxpayers and public budgets
- Solves only part of the problem: Coverage after a waiting period relies on private insurance or savings for initial care, but the private long-term care insurance market is weak.
Where it has been tried
- UK proposals (Dilnot cap): Lifetime cap on care costs proposed.
- UK: In England in 2011, the Dilnot Commission recommended a £35,000 cap on lifetime individual care contributions, while its briefing described one in ten people over 65 facing care costs exceeding £100,000.Sources: The King's Fund (2011)