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Long-Term Care Annuities: Pros and Cons


Requiring long-term care later in life can be pricey. According to, the average annual cost of nursing care in a semi-private room was $94,900 in 2023. Paying that much money could soon exhaust many seniors’ assets. Buying long-term care insurance is one option for offsetting these costs, but rising premiums can make that expensive. A long-term care annuity may be a better choice for helping you plan for the future. If you have questions about long-term care planning, consider speaking with a financial advisor.

What Is a Long-Term Care Annuity?

An annuity is an insurance contract in which you pay a premium, either upfront or monthly, to receive payments back from the insurance company at a later date. An annuity can be immediate, meaning your annuity payments begin within a year of paying the initial premium. Or it may be deferred, with payments beginning at a specified date in the future, such as your 65th birthday.

A long-term care annuity is a deferred annuity that includes a long-term care rider. A rider is essentially an add-on you can include when purchasing an annuity that offers extra features or benefits. You purchase the annuity with the long-term care rider and when you eventually need long-term care, you can begin receiving payments to help with those expenses. Payments can be made to you monthly or as a lump sum. Your annuity company can give you the money to use as needed or reimburse you after the fact for long-term care expenses you’ve already paid.

To activate the long-term care rider and begin receiving benefits from the annuity, you generally have to meet medical standards that necessitate long-term care. For example, that might mean being diagnosed with a chronic or terminal illness, such as Alzheimer’s disease or another degenerative disease that requires round-the-clock care, either in home or in a nursing facility.

Annuities grow with interest and a long-term care annuity can either be fixed or variable. With a fixed annuity, you’re earning a guaranteed rate of return. This type of annuity is generally considered a safe investment since your returns are predictable. A variable annuity tends to be riskier but it offers the opportunity to earn higher returns if the underlying investments perform well.

What Are the Pros of a Long-Term Care Annuity?

Long-Term Care Annuities

Adding a long-term care rider to an annuity may be the right move if you’re looking for long-term care coverage but don’t want a separate insurance policy. You can enjoy the best of both worlds, in the form of a regular annuity payment that you can rely on for retirement income with the option to use the long-term care rider if necessary to pay for nursing care costs.

If you have an existing health issue, you might find it easier to get approved for an annuity with a long-term care rider versus long-term care insurance. For example, you may run into fewer hassles with a long-term care annuity if you’ve had a hip replacement or similar surgery compared to long-term care insurance. Note that some conditions, such as Parkinson’s disease may not be eligible for coverage either with a long-term care rider or a regular long-term care policy.

Cost-wise, a long-term care annuity could also be a more budget-friendly option. Long-term care insurance premiums are dependent on several factors, including your home state, your age, gender, whether you need coverage for just yourself or yourself and a spouse, how long you want the policy to pay out benefits and the dollar amount of benefits you’d like the policy to pay. With a long-term care rider, your age and overall health can affect the cost but you may pay less in premiums to get covered.

What Are the Cons of a Long-Term Care Annuity?

Getting an annuity with a long-term care rider does have some upsides but there are a few drawbacks to keep in mind. For one thing, you may be expected to make a large upfront premium payment to get covered. And the more likely you are to need long-term care at some point, based on the insurance company’s risk assessment, the higher that premium might be.

Paying it could be challenging if you don’t have a lot of liquid cash reserves to tap into. You might have to sell off some of your investments or withdraw money from a 401(k) or IRA to cover the premium payment, which could trigger a tax penalty.

Speaking of taxes, it’s important to mention that annuity payments are taxable. The tax treatment depends on how you purchase them. Suppose you buy an annuity inside a qualified plan, such as a 401(k) or IRA. In that case, the entire annuity is taxable, including the money you used to purchase it and any earnings. If you buy an annuity using after-tax dollars then only the earnings are taxed. Long-term care insurance benefits generally wouldn’t be taxable.

Long-Term Care Annuity vs. Long-Term Care Insurance

A long-term care annuity is different from long-term care insurance in a few ways. With long-term care insurance, you’re buying an insurance policy specifically for long-term care. You may pay an upfront premium or monthly premium. Once you need long-term care, the policy can pay out monthly or on a lump-sum basis to help with those costs.

Long-term care insurance doesn’t have the growth component that a long-term care annuity would. Another key difference is that if you don’t need long-term care, you don’t get the premiums you paid back unless you purchase a return premium rider.

With a long-term care annuity, you could still receive annuitized payments even if you don’t use the long-term care rider’s benefits. In other words, it’s a form of guaranteed income that you can use for long-term care if needed or other expenses in retirement.

Bottom Line

Long-Term Care Annuities

A long-term care annuity could be right for you if you think you may need long-term care down the road. Medicare doesn’t pay for nursing care, and while Medicaid can, you might have to spend down your assets before you can get approval for benefits. An annuity with a long-term care rider can give you regular income, and at the same time prepare you for the worst-case scenario if long-term care is something you eventually end up needing. As with all financial goals, planning is key to long-term care.

Tips for Investing

  • Consider talking to a financial advisor about your options for preparing for long-term care costs. 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.
  • A related concern is how much regular life insurance you need. SmartAsset’s life insurance calculator will give you a good idea of how much life insurance you should have.

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