Travel goals, charitable giving, and portfolio strategy typically take center stage. Yet one of the most common and expensive chapters of retirement is also the most overlooked: the slow, uncertain, and deeply personal need for help with daily living.
Here’s the reality: most high-net-worth individuals will face a period of physical or cognitive decline. And they’ll largely fund it themselves. Medicare doesn’t cover extended long-term care, and Medicaid wasn’t designed for people with means.
That makes long-term care a private problem. One that deserves a deliberate plan.
Rethinking the Default
The typical mindset is to treat long-term care as a “maybe”—something to handle later. But that mindset is flawed. A more strategic approach is to assume care will be needed. If you never require it, great. But if you do, you’re ready.
This is especially important for affluent families, where the financial capacity to choose better care is only as strong as the plan behind it. The last thing you want is a scramble for decisions when you’re least able to make them.
Long-Term Care Insurance—Is It Worth It?
Traditional long-term care insurance (LTCI) has a checkered past: underpriced policies, rising premium, and insurer exits. But the market has evolved.
Today’s hybrid products—life insurance or annuities with long-term care riders—offer more predictability and preserve value if care isn’t needed. These may be particularly attractive for those with excess cash or assets earmarked for heirs but flexible in purpose.
If you have an old LTCI policy, don’t rush to cancel. Despite higher premiums, many still offer strong value. Have it reviewed objectively for its current benefit and cost structure.
Other Funding Strategies
Even without insurance, several smart options exist:
Segregated Assets: Earmark a portion of your portfolio or home equity for future care costs. Label it mentally—and perhaps legally—as a care reserve.
Health Savings Accounts (HSAs): If you’re eligible, HSAs are one of the most tax-advantaged tools available and can help fund qualified medical expenses, including many long-term care costs.
Family Planning Agreements: Formal or informal, conversations with adult children or other caregivers can prevent confusion and resentment later. Decide now who does what—and who pays.
Medicaid Planning: While not typically relevant for the ultra-wealthy, some strategic planning might preserve flexibility if eligibility ever becomes a consideration.
Planning for Cognitive Decline
Physical disability is one thing—cognitive decline is another. Set up your decision-making infrastructure early. Make sure power of attorney, healthcare proxy, and successor trusteeships are in place—and that the people filling them understand your wishes.
Start the Conversation—Now
These aren’t easy topics, but they’re too important to ignore. Use your next portfolio or estate planning review to introduce the question: “What’s my plan if I need care?” You’re not asking for pessimism—you’re modeling foresight.
Wealth offers options. But only if you’ve prepared for the hard chapters, not just the ideal ones.
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