Long-Term Care Insurance: 7 Critical Strategies

**Could your seven-figure portfolio actually disappear due to long-term care costs?** Most affluent families assume their wealth provides complete protection—but that's dangerously incomplete thinking. In this episode, we explore seven critical strategies for long-term care insurance that go beyond conventional wisdom. According to the U.S. Department of Health and Human Services, roughly 70% of Americans turning 65 will need some form of long-term care. With private nursing facilities now costing six figures annually, even high-net-worth individuals face significant wealth erosion without proper planning. We'll discuss how a fiduciary approach to financial planning, combined with comprehensive wealth management strategies, can preserve your legacy. Whether you're in Florida or beyond, these tax-efficient tactics help protect your retirement assets from catastrophic care costs. Ready to talk? Schedule a complimentary discovery call at TDWealth.net. For educational purposes only. Not investment advice. 📖 Full show notes: https://tdwealth.net/long-term-care-insurance-7-critical-strategies/

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Davies Wealth Management

684 SE Monterey Road

Stuart, FL 34994

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Transcript

SPEAKER_01 0:00

If you have like five million dollars in the bank, the absolute worst thing you can do to pay for a long-term care event is, well, write a check out of pocket.

SPEAKER_00 0:08

Trevor Burrus, Jr.: Right. I mean, it goes against every single instinct you develop while building wealth.

SPEAKER_01 0:13

Yeah, exactly.

SPEAKER_00 0:14

You just assume that accumulating this massive portfolio means you've you've insulated yourself. You look at your net worth and just think, huh, I can cash flow whatever medical hurdles come my way.

SPEAKER_01 0:25

Aaron Powell But today we're completely dismantling that exact myth. We are doing a deep dive into the this really comprehensive strategy guide meant for the 1715 Treasure Coast Financial Wellness podcast. It's put together by Davies Wealth Management, which is a fee-based fiduciary advisory firm down in Stewart, Florida. And uh reading through this material, the massive aha moment for me right up front is that insurance for high net worth individuals operates on a completely different set of rules.

SPEAKER_00 0:54

Oh, entirely.

SPEAKER_01 0:55

We aren't talking about like buying medical coverage. We are talking about defensive asset preservation. Yeah.

SPEAKER_00 1:00

Right. Because mass market financial advice treats long-term care as this binary consumer purchase, like you either buy a policy or you don't.

SPEAKER_01 1:09

Yeah.

SPEAKER_00 1:09

But when you apply that logic to portfolios of$2 million,$5 million, or you know,$10 million, it just totally falls apart. The affluent often fall into this trap of assuming self-insurance is the logical default.

SPEAKER_01 1:25

Just because the money is sitting there.

SPEAKER_00 1:27

Exactly. Just because they have the liquidity.

SPEAKER_01 1:29

So let's look at the actual mechanics of why that self-insurance default is so dangerous. We're starting with some pretty sobering statistics here from the U.S. Department of Health and Human Services.

SPEAKER_00 1:40

Yeah, these are wild.

SPEAKER_01 1:41

Roughly 70% of Americans turning 65 will need some form of long-term care. 70%. And the baseline cost for a private room in a nursing facility, it's hovering around$115,000 a year nationwide.

SPEAKER_00 1:56

Aaron Powell And that's just the baseline. I mean, in coastal or metro markets like where Davies operates in Florida, you're easily looking at over$150,000. But you know, the real danger for high net worth individuals isn't just that sticker price, it's the duration.

SPEAKER_01 2:10

Aaron Powell The duration. What do you mean?

SPEAKER_00 2:12

Well, wealthier individuals generally have access to better preventative health care, right? Optimal nutrition, lower occupational stress throughout their lives. Consequently, they live longer.

SPEAKER_01 2:24

Right.

SPEAKER_00 2:24

But that expanded lifespan doesn't automatically equal an extended health span. So when physical or cognitive decline eventually happens, they often survive much longer in a diminished state.

SPEAKER_01 2:35

Oh, wow. Okay. So instead of the generic like two to three years of care that those mass market planning articles always cite, exactly. Wait, we are looking at an extended morbidity phase. A slow cognitive decline could necessitate round-the-clock care for five, seven, or uh even eight years.

SPEAKER_00 2:53

Yeah, and then you have to layer healthcare inflation on top of that extended timeline.

SPEAKER_01 2:57

Yes. Inflation.

SPEAKER_00 2:58

Right. Healthcare costs compound at roughly 5% annually. So if you're 55 now and looking at a potential care event at age 80, that compounding math is just brutal.

SPEAKER_01 3:08

It's exponential.

SPEAKER_00 3:09

Yeah. A$120,000 annual cost today, balloons, to nearly$195,000 in just 10 years.

SPEAKER_01 3:21

That's insane.

SPEAKER_00 3:22

Multiply that by a seven-year care event. And I mean, you are bleeding millions of dollars from the portfolio.

SPEAKER_01 3:28

Which introduces the single most destructive mechanism to a retirement portfolio, right? Sequence of return risk.

SPEAKER_00 3:34

Oh, absolutely. The silent killer.

SPEAKER_01 3:37

It really is. I was thinking about it like this. It's like treating your carefully balanced retirement portfolio as an unlimited checking account while the stock market is crashing.

SPEAKER_00 3:47

That's a great way to put it.

SPEAKER_01 3:48

If I need 150 grand to pay for premium home health care and the market is going through a 20% correction, I'm not just pulling out 150 grand. I'm being forced to liquidate shares that used to be worth nearly$200,000.

SPEAKER_00 4:01

Aaron Powell Exactly. You are locking in those losses. Those shares are gone forever. They can never participate in the eventual market recovery. Trevor Burrus, Jr.

SPEAKER_01 4:09

Right. You're selling at the absolute bottom.

SPEAKER_00 4:11

Aaron Powell You permanently impair the portfolio's compounding engine. Even an$8 million portfolio can suffer irreversible structural damage if you're forced to systematically sell off your best performing assets during a prolonged bear market.

SPEAKER_01 4:26

Just to cover nursing costs.

SPEAKER_00 4:27

Just to cover the nursing costs, yeah. And the collateral damage to the healthy spouse is severe.

SPEAKER_01 4:32

Yeah, they have to just sit there and watch their shared nest egg evaporate.

SPEAKER_00 4:35

Aaron Powell Which radically alters their own future financial security. So if paying annual premiums for traditional insurance feels like throwing money into a black hole, because those old standalone policies are famous for massive arbitrary rate hikes.

SPEAKER_01 4:50

Oh, yeah, those are terrible.

SPEAKER_00 4:52

Right. But the alternative isn't not paying, the alternative is repositioning.

SPEAKER_01 4:57

Repositioning. Okay, so if self-insuring is a trap and traditional standalone policies are famously awful, what is the alternative? How are the wealthy actually structuring this coverage?

SPEAKER_00 5:08

Well, the traditional use it or lose it insurance model has largely been abandoned by affluent families for that exact reason you mentioned. Nobody wants to pay premiums for two decades and then pass away peacefully in their sleep, having forfeited all that capital to the insurance company.

SPEAKER_01 5:24

Nobody. It feels like a scam.

SPEAKER_00 5:26

It does. So the modern mechanism relies on hybrid policies. These fuse life insurance, or sometimes an annuity, with long-term care benefits.

SPEAKER_01 5:35

Okay, wait, let me push back on this for a second. If I lock up, say,$200,000 in a hybrid policy and then I step off a curb and get hit by a bus tomorrow, isn't that money just gone?

SPEAKER_00 5:45

No. Actually, that's the genius of it. The underlying math is entirely built around the concept of a return of premium.

SPEAKER_01 5:51

Okay.

SPEAKER_00 5:51

If you take$200,000 of cash and park it in a single premium hybrid policy, that money is not gone. If you never require a single day of long-term care, your beneficiaries receive a tax-free death benefit.

SPEAKER_01 6:03

Oh, wow. So it just functions as an estate transfer.

SPEAKER_00 6:06

Exactly. The capital is simply parked in a different vehicle. But if you do trigger a care event, that same$200,000 premium creates massive morbidity leverage.

SPEAKER_01 6:18

Meaning it pays out way more than you put in.

SPEAKER_00 6:20

Right. It might unlock a pool of$500,000 or even$800,000 in tax-free long-term care benefits. You're basically trading a highly inefficient, taxable, liquid asset for highly leveraged tax-free protection.

SPEAKER_01 6:34

That's incredible leverage. And because these are funded with a single lump sum or maybe a guaranteed short-term payment schedule like over five years, you completely eliminate that premium hike risk.

SPEAKER_00 6:45

Precisely.

SPEAKER_01 6:45

The insurance company can't suddenly demand higher payments when you turn 80, which, you know, brings up the concept of lazy capital because high net worth portfolios are full of it.

SPEAKER_00 6:54

They really are. Every affluent portfolio has pockets of underperforming liquidity. It might be uh$500,000 sitting in low-yielding certificates of deposit, a money market account, or maybe an outdated non-qualified annuity. Trevor Burrus, Jr.

SPEAKER_01 7:08

Just safe money sitting there doing nothing.

SPEAKER_00 7:10

Aaron Powell Right. It's money the family does not need for daily operational living expenses. So you take that lazy capital and upgrade its efficiency. You move it into an asset-based long-term care vehicle.

SPEAKER_01 7:20

And you still maintain control, right?

SPEAKER_00 7:22

Yep. Since many of these contracts offer a surrender value if you change your mind. But you've instantly created this massive liquidity buffer if health goes sideways.

SPEAKER_01 7:31

Okay, so that's individuals. What about married couples? Because paying for two of these massive policies seems like a lot of capital to tie up.

SPEAKER_00 7:40

Yeah, that leverage becomes even more efficient when we look at how married couples structure these vehicles. Instead of buying two separate isolated policies, they utilize shared care pools.

SPEAKER_01 7:50

Shared care pools, how does that work?

SPEAKER_00 7:52

Well statistically, it's incredibly rare for both spouses to suffer extended multi-year maximum benefit care events simultaneously. Usually one spouse requires significant prolonged care, while the other might need very little.

SPEAKER_01 8:06

Right, that makes sense.

SPEAKER_00 8:08

By establishing a shared pool, say, a combined benefit of$1 million, either spouse can draw from it.

SPEAKER_01 8:14

Oh, I see.

SPEAKER_00 8:14

So if the husband requires$700,000 of care over six years, he isn't capped at a personal$500,000 limit. He pulls from the shared pool, maximizing the utility of every premium dollar spent while preserving the core portfolio for the healthy spouse.

SPEAKER_01 8:32

That is so smart. Okay, let's step away from the specific insurance products for a minute, because from what I read in the Davies Guide, liquidating cash isn't just about the loss of the underlying asset. No. It's about the collateral damage to the tax return. I was thinking about it like playing financial Jenga.

SPEAKER_00 8:49

Ooh, I like that.

SPEAKER_01 8:50

You pull out one block at the bottom to pay for a home health aid, and suddenly your Medicare premiums and tax brackets crash down on your head.

SPEAKER_00 8:58

That is exactly what happens. Think of your tax structure like a terraced fountain. You've spent years carefully managing how much income flows into the top tiers so it doesn't spill over into higher marginal brackets. Right. The moment you were forced to take an unbudgeted, massive distribution from a traditional IRA to pay for a health aid, you flood that fountain. Pulling an extra$150,000 of taxable income pushes you aggressively into the 32 or 35% federal tax brackets.

SPEAKER_01 9:26

Which is brutal on its own. But the guide points out a more insidious trap: the CLIF penalty of IRAA.

SPEAKER_00 9:33

Yes, IRMA.

SPEAKER_01 9:34

The income-related monthly adjustment amount. That force distribution doesn't just bump your marginal bracket, it throws you off the IRMAA cliff, instantly causing your Medicare Part B and Part D premiums to just skyrocket.

SPEAKER_00 9:47

It acts as a delayed financial time bomb, too, because of Medicare's two-year look back period.

SPEAKER_01 9:51

Wait, a two-year look back?

SPEAKER_00 9:53

Yeah. The IRS uses your tax return from two years prior to determine your current Medicare premiums. Oh wow. So a massive IRA withdrawal to pay for a care event in, say, 2026 will trigger punitive Medicare surcharges in 2028.

SPEAKER_01 10:06

That is a nightmare.

SPEAKER_00 10:07

And furthermore, if you're executing a multi-year Roth conversion ladder, you know, methodically paying taxes now at historically low rates to create a tax-free bucket for later. That sudden surge in taxable income destroys your conversion space entirely.

SPEAKER_01 10:22

Your carefully engineered Roth strategy is just completely neutralized by the care costs.

SPEAKER_00 10:27

Exactly. So the long-term care policy acts as a firewall. By having the insurance company pay those costs with tax-free benefits, you retain absolute control over the timing and volume of your taxable distributions.

SPEAKER_01 10:38

And that firewall concept extends directly to advanced estate planning, too, doesn't it? Which is highly relevant right now due to the looming 2026 sunset of the Tax Cuts and Jobs Act.

SPEAKER_00 10:48

Oh, it's huge. The historically high federal estate tax exemptions are scheduled to be cut in half in 2026. Wealthy families have spent the last few years and tens of thousands of dollars in legal fees setting up irrevocable trusts.

SPEAKER_01 11:01

Right, like spousal lifetime access trusts, complex annual gifting strategies, just trying to shield their wealth from that impending tax clash.

SPEAKER_00 11:09

But long-term care costs are paid with after tax dollars. If you're burning through$180,000 a year for six years, you are draining over a million dollars out of the estate.

SPEAKER_01 11:19

After tax.

SPEAKER_00 11:20

Yes. So the capital required to fund those perfectly engineered trusts just vanishes. The legal scaffolding remains, but the assets meant to populate it have been liquidated to pay the nursing facility.

SPEAKER_01 11:33

That would be devastating. So the insurance benefit ensures the estate plan functions exactly as the attorneys designed it, regardless of the client's medical fate.

SPEAKER_00 11:42

Exactly. And, you know, there's also an offensive tax play here, specifically for business owners.

SPEAKER_01 11:47

Oh, right. Because individual taxpayers really struggle to deduct long-term care premiums.

SPEAKER_00 11:52

Right, because they're subject to a strict 7.5% adjusted gross income floor. But the corporate tax code offers a massive workaround.

SPEAKER_01 12:01

So how does that work for, say, a C Corp?

SPEAKER_00 12:04

Well, the tax code effectively subsidizes wealth protection for entrepreneurs. Under section 162 of the Internal Revenue Code, a C corporation can typically deduct the absolute full cost of a long-term care premium as a legitimate business expense.

SPEAKER_01 12:19

Full cost. Wow.

SPEAKER_00 12:21

Yeah, and there are no age-based limits like there are for individuals.

SPEAKER_01 12:24

So you're basically utilizing pre-tax corporate dollars to fund a personal asset protection vehicle.

SPEAKER_00 12:31

Exactly. Now, S-corporation owners and LLCs have slightly different mechanisms, but the underlying principle remains. The business entity absorbs the cost of defending the owner's personal balance sheet.

SPEAKER_01 12:45

That's an incredible strategy. But um, none of these tax strategies, hybrid pools, or asset-based repositionings matter if the primary door is locked.

SPEAKER_00 12:53

No, they don't.

SPEAKER_01 12:54

The most urgent vulnerability outlined in the Davies Guide is the unforgiving reality of medical underwriting.

SPEAKER_00 13:00

Yeah, this is where people really get caught off guard.

SPEAKER_01 13:02

Right. I mean, I have this naive question when I first started reading. I thought, why can't I just wait until my doctor tells me my memory is slipping or my knees are shot to buy a policy?

SPEAKER_00 13:10

You and everyone else. But the underwriting window for long-term care slams shut with zero warning. And the mechanics of this underwriting are drastically more restrictive than life insurance.

SPEAKER_01 13:21

How so?

SPEAKER_00 13:22

Well, from an actuary's perspective, a life insurance payout is a binary one-time event. They know they will pay out exactly once. Right. But long-term care represents an open-ended, multi-year bleed on the insurer's reserves. So the risk tolerance of the insurance company is practically zero. Aaron Powell, Jr.

SPEAKER_01 13:40

So if you have like a minor issue, what happens?

SPEAKER_00 13:43

If you show a slight hand tremor that suggests early stage Parkinson's, or you have a history of a transient ischemic attack, a mini stroke, or even if you just utilize a mobility aid, it is an automatic decline.

SPEAKER_01 13:55

An automatic decline. They don't just offer you a policy with a higher premium.

SPEAKER_00 13:58

No, they refuse to issue the contract entirely. Any notation of cognitive impairment in your medical records renders you permanently uninsurable.

SPEAKER_01 14:05

Permanently. Wow. So the optimal window to secure this leverage is really between ages 50 and 65.

SPEAKER_00 14:11

Yes. The sweet spot. Once you cross 70, the available product pool shrinks significantly. By 75, the hybrid vehicles are essentially non-existent or just mathematically prohibitive.

SPEAKER_01 14:24

And this timing issue exposes some specific professional demographics to massive risk. I thought this part of the guide was fascinating. I can clearly see why professional athletes are vulnerable given the physical toll of their careers.

SPEAKER_00 14:38

Let's examine the athlete first. A professional athlete often exits their primary earning window in their mid-30s.

SPEAKER_01 14:44

Right, super young.

SPEAKER_00 14:45

They've accumulated significant capital, sure, but they face a 50 to 60 year time horizon in retirement. Combine that unprecedented timeline with severe joint deterioration or the elevated risk of CTE chronic traumatic encephalopathy from their sport, and early underwriting is critical.

SPEAKER_01 15:02

They have to secure coverage before those occupational hazards morph into uninsurable pre-existing conditions.

SPEAKER_00 15:07

Exactly.

SPEAKER_01 15:08

The other group surprised me. Because their wealth is heavily concentrated, right? And deferred compensation packages, restricted stock units, private business equity.

SPEAKER_00 15:20

That is the exact vulnerability. An executive's net worth might look phenomenal on paper, but a massive portion of it is illiquid. If a severe care event occurs during a trading blackout window or right when the company's stock has taken a temporary 40% hit due to macro conditions, they cannot easily liquidate. No, they're trapped. The insurance policy provides an immediate, highly liquid buffer of cash, allowing their concentrated positions the time they need to mature or recover.

SPEAKER_01 15:51

Okay, so for those listening who are in that 50 to 65 sweet spot and are ready to actually evaluate policies, the guide had some rapid-fire takeaways on what to look for. Because the mechanics of the policy features dictate how effective the protection will actually be.

SPEAKER_00 16:05

Right. And the most critical engine of any policy is the compound inflation protection. If you do not attach a compound inflation rider, you are buying a depreciating asset.

SPEAKER_01 16:15

Because of that 5% healthcare inflation we talked about earlier.

SPEAKER_00 16:18

Exactly. Utilizing the rule of 72, a 3% compound inflation rider will cause your daily benefit to double roughly every 24 years. So if you secure the policy at age 55, you need the mathematical certainty that the benefit will be twice as large when you actually enter a care facility at age 79.

SPEAKER_01 16:39

That makes total sense. And you also have to leverage your own liquidity to lower the cost of the contract, right?

SPEAKER_00 16:45

Yes.

SPEAKER_01 16:46

This involves the elimination period, which functions basically like the deductible. It's the waiting period before the insurance company starts writing checks.

SPEAKER_00 16:54

Right. A mass market consumer might need a short 30-day elimination period because they can't afford to self-fund a month of care. But a high net worth family has the liquidity to easily cash flow the first 90 or even 180 days of a care event.

SPEAKER_01 17:08

So by accepting a longer elimination period, you drastically reduce the internal cost of the insurance.

SPEAKER_00 17:13

Exactly, creating a much more efficient use of capital.

SPEAKER_01 17:16

Yeah.

SPEAKER_00 17:16

And crucially, you have to verify the mechanics of the home care coverage.

SPEAKER_01 17:21

Oh, right. Because affluent individuals overwhelmingly prefer to age in place.

SPEAKER_00 17:26

Yes. Receiving customized care in their own residences rather than relocating to an institutional facility. The contract language must explicitly cover premium home health aids without restrictive facility mandates.

SPEAKER_01 17:40

So the sum of all these mechanisms points back to the central philosophy of the Davies wealth management material. You are not making an insurance decision. You are making a foundational wealth preservation decision.

SPEAKER_00 17:52

That's the core of it.

SPEAKER_01 17:53

You're building a moat around your independence. You are shielding your spouse from the devastating psychological and financial burden of liquidating the life you built together.

SPEAKER_00 18:04

True financial security requires acknowledging that accumulating assets is only the first half of the equation. The second half is defending those assets against forced liquidations, sequence of return risk, and the cascading tax penalties triggered by healthcare inflation. You must dictate the terms of your protection while you still possess the medical leverage to do so.

SPEAKER_01 18:23

And whether you have$1 million,$10 million, or you're still building toward those numbers, that the core lesson really applies, which leaves us with a fascinating and frankly kind of lingering variable to consider regarding the future of legacy planning. Yeah. Medical science is advancing at a staggering pace, right? It's fundamentally expanding our physical lifespans and keeping our biological systems running decades longer than historical norms. But our independent health spans, our cognitive sharpness and physical autonomy are not necessarily pacing those biological advancements.

SPEAKER_00 18:57

They're just not.

SPEAKER_01 18:58

So if you or the generation above you survive into a decade long window requiring constant, intensive medical supervision, how will that single unbudgeted variable fundamentally rewrite the concept of generational wealth for your family tree?