Who is the largest player of long-term care services?
Medicaid is the largest payer and primary funding source for long-term services and supports (LTSS) in the United States, covering roughly 61% to 66% of total long-term care costs and serving about two-thirds of nursing home residents.
If you are looking for the largest corporate operator or provider of skilled nursing and long-term care facilities in the U.S.:
- The Ensign Group is ranked as the nation's largest operator by the Centers for Medicare & Medicaid Services (CMS) data, followed closely by large regional and national operators like PACS Group and Genesis HealthCare.
- Genworth is the largest private provider by policyholders for long-term care insurance.
Who is the largest payer of LTSS?
Medicaid is the largest single payer of Long-Term Services and Supports (LTSS) in the United States.
Key Spending Details
Who are the top 10 long-term care insurance providers?
The top providers of long-term care (LTC) insurance and hybrid life/LTC policies include major carriers like Mutual of Omaha and New York Life, which still offer active policies.
Top Long-Term Care Insurance Providers
- Mutual of Omaha: Known for selling the highest volume of traditional, standalone individual LTC policies with flexible issue ages up to 79.
- New York Life: Recognized for strong financial strength and comprehensive traditional policies, plus hybrid asset-flex options.
- Northwestern Mutual: Offers robust traditional coverage limits and strong dividend-paying history, though policies tend to be higher-priced.
- Genworth Financial: Historically the largest provider measured by total in-force policyholders, though it focuses more on servicing legacy block and select online configurations.
- Thrivent Financial: Offers high monthly maximum benefit limits and customizable traditional or hybrid designs.
- Nationwide: A prominent choice for hybrid life insurance policies featuring built-in long-term care riders with cash indemnity options.
- Lincoln Financial Group: Popular for its MoneyGuard hybrid universal life and asset-based LTC products featuring quick-start or zero-day waiting periods.
- MassMutual: Noted for integrating long-term care riders directly into participating permanent whole life policies.
- National Guardian Life: Offers standalone traditional coverage (such as EssentialLTC) that features options for lifetime maximum benefit periods.
- Brighthouse Financial: Recognized for indexed universal life hybrid plans providing flexible inflation and care protection.
Opinions on Reddit are mixed regarding asset-based hybrid policies versus traditional stand-alone coverage, with some preferring hybrids for the guaranteed death benefit if care isn't needed, and others advising that standalone policies provide dedicated care funding more efficiently.
Who is the biggest nursing home owner?
The Ensign Group is the nation's largest nursing home operator by facility and bed count according to recent federal data from the Centers for Medicare & Medicaid Services.
Largest Nursing Home Operators
- The Ensign Group: Leads the country in facility count and scale across multiple states.
- Genesis HealthCare: Historically one of the largest operators and networks with hundreds of facilities.
- Life Care Centers of America: The largest privately-owned skilled nursing company, owned by billionaire Forrest Preston.
- Brookdale Senior Living: The largest corporate-owned chain when including assisted living and residential care alongside nursing.
What percentage of LTC is paid by Medicaid?
Medicaid pays approximately 61% of all total long-term care (LTC) spending in the United States.
National Spending and Coverage Share
- Overall LTC Spending: Medicaid covers about 61% of total long-term services and supports (LTSS) expenditures nationally.
- Nursing Homes: Medicaid covers roughly 63% of all nursing home residents in the country.
- Assisted Living: Medicaid covers about 18% of assisted living facility residents.
How Medicaid Payment Works for Individuals
- Approved Coverage: For individuals who qualify based on income and asset limits, Medicaid covers the approved cost of care at a certified facility, but it does not mean the individual pays nothing.
- Share of Cost (Patient Liability): Residents must generally contribute most of their monthly income (such as Social Security or pensions) toward the cost of their care.
- Personal Needs Allowance: The state allows the resident to keep a very small amount of their monthly income—typically ranging from $30 to $200 depending on the state—for personal necessities.
You are ONE diagnosis away from needing Long Term Care
What does Dave Ramsey say about long-term care?
Dave Ramsey says that long-term care insurance is a mathematically worthwhile tool to protect your retirement savings from being wiped out by nursing home, assisted living, or in-home care costs.
Key Recommendations
- When to Buy: He recommends purchasing a policy around the age of 60, as the risk of needing care before 60 is low, but premiums and health disqualifications rise sharply after that window.
- Who Needs It: He suggests it for people with assets roughly between $200,000 and $5 million. If you have a massive net worth, you can choose to self-insure, while those with very little may rely on Medicaid after depleting assets.
- What to Avoid: He warns against bundling long-term care with life insurance, calling combo products a rip-off compared to stand-alone policies.
- Coverage Goal: Policies should cover assisted living, nursing homes, and in-home help so that a spouse or children are not left in financial hardship.
You can read more details on his approach through the Ramsey Solutions Long-Term Care Guide.
Who pays the most long-term care expenses?
Medicaid pays the largest share of formal long-term care expenses in the United States, accounting for roughly 45% to 46% of total spending.
Major Payers of Long-Term Care
- Medicaid: The largest public and overall payer, covering extended custodial and nursing home care, but it requires individuals to "spend down" their personal assets and income to very low limits before qualifying.
- Out-of-Pocket Spending: Individuals and families pay the second-largest portion overall (roughly 14% to 38% depending on the specific care setting and metrics used), funding care directly through personal savings, retirement funds, and home equity until funds run out.
- Medicare: Covers short-term skilled nursing, rehabilitation, or hospice care (up to 100 days), but it does not cover long-term or custodial daily living assistance.
- Private Long-Term Care Insurance: Covers a relatively small percentage of overall nationwide expenses because policies can be expensive and many people do not carry them.
- Other Sources: Include the Department of Veterans Affairs (VA) for eligible veterans and unpaid informal care provided by family members.
What are the top 10 worst long-term care insurance companies in the USA?
The worst-performing or most problematic long-term care (LTC) and related insurers are typically identified by severe premium hikes, high complaint volumes, claim denials, or financial insolvency. According to industry evaluations and consumer risk reports like those outlined by WiseWorQ, ten companies frequently cited for poor long-term care management or related practices include:
- Penn Treaty American: Faced complete insolvency and state-ordered liquidation, leaving policyholders scrambling or facing terminated coverage.
- Genworth Financial: Known for massive financial instability pressures and staggering premium hikes exceeding 100% for legacy policyholders.
- Conseco / CNO Financial Group: Noted historically for hardball tactics, high consumer complaints, and frequent claim delay lawsuits regarding long-term health benefits.
- Unum: Frequently targeted in litigation and regulatory actions for denying or delaying legitimate claims contrary to medical evaluations.
- Bankers Life & Casualty: Carries a high consumer complaint index regarding delayed processing and service friction.
- Transamerica: Racks up high complaint volumes paired with severe premium increases and processing delays.
- Ability Insurance: Plagued by an extremely high complaint index, restrictive claim handling, and poor customer service reviews.
- SILAC (Salt Lake Insurance Agency Company): Frequently flagged for rapid premium rate hikes and administrative claim delays.
- RiverSource Life Insurance: Noted for high customer complaint ratios, claim processing slowdowns, and steep cost increases.
- Medico: Associated with high rates of service dissatisfaction, communication opacity, and frustrating denial practices.
Who does Suze Orman recommend for long-term care insurance?
Suze Orman recommends long-term care specialist Phyllis Shelton and her team at BuddyIns (or via Got LTCi) as her primary expert and go-to resource for long-term care insurance (LTCi).
Key Details of the Recommendation
- The Expert: Phyllis Shelton, whom Orman calls the top long-term care expert in the United States and a former trainer for LTC insurance agents.
- How to Contact: Clients can reach out through the BuddyIns Suze Orman Program or email Shelton directly at [email protected], mentioning that "Suze sent you".
- Consultations: Consultations through her recommended specialists are structured to be free and non-sales pressured.
Who is the most common payer for long-term care services?
Medicaid is the most common payer for long-term care services in the United States. It covers nearly half of all paid long-term care costs.
Breakdown of Payers
- Medicaid: Pays for about 45% to 60% of long-term care. It helps people with low income and few remaining savings. It covers nursing homes, assisted living, and home care.
- Personal Funds (Out-of-Pocket): Families and individuals pay for about 38% to 44% of care using their own savings, pensions, or home sales.
- Medicare: Does not pay for long-term or custodial care. It only pays for short-term medical care or rehab after a hospital stay (up to 100 days).
- Private Insurance: Traditional health insurance and standard policies cover very little long-term care.