Affluent families are rethinking self-insuring for long-term care

LTC Simple founder Carol Guilbault says high-net-worth households should not assume they can simply self-fund long-term care without weighing the tradeoffs. Her point comes as 2025 care-cost data show nursing homes, assisted living and in-home care can still create a major financial burden.

Why it matters: - High-net-worth households may be able to pay for long-term care, but they still face the risk of draining investments, retirement accounts, savings and income. - Planning for care is also about preserving choice, independence and flexibility over where care is received. - Current care costs are high enough that even affluent families may want to transfer part of the risk instead of keeping all of it.

What happened: - Carol Guilbault, founder of LTC Simple and a long-term care insurance specialist since 2001, argued that wealthy families should rethink the assumption that self-insurance is always the best option. - Guilbault said many people with $2 million to $5 million in assets tell her they can afford to self-insure, but affordability is not the same as optimal planning. - CareScout’s 2025 Cost of Care Survey put the national median cost of a private nursing home room at $129,575 per year. - The same survey found assisted living at $74,400 annually and a non-medical caregiver providing 44 hours of care per week at $80,080 per year.

The details: - Self-insuring means a household keeps the full financial risk instead of transferring part of that risk through insurance. - Guilbault said affluent families can use a mix of strategies, including self-funding part of future care and covering the rest with traditional long-term care insurance or hybrid and asset-based products. - Guilbault framed the planning discussion around two questions: where a person wants to receive care and which financial resources would pay for it. - Long-term care insurance generally requires medical underwriting, which means waiting can narrow coverage options. - Guilbault said people can explore coverage and decide they do not need it, but waiting until care is needed is no longer planning.

Between the lines: - The core shift is not about whether wealthy families can pay for care. It is about whether they want to expose their assets to an open-ended expense. - Guilbault is also pushing a broader planning message: families often insure other assets they could replace, but treat long-term care differently. - The message positions long-term care insurance as a risk-management tool, not just a product for people who cannot self-fund.

What's next: - Families evaluating long-term care coverage will likely need to decide sooner rather than later because medical underwriting can limit access over time. - Guilbault said the right next step is to do the analysis first, then decide whether self-funding, insurance or a combination of both best fits the household. - LTC Simple continues to help families evaluate traditional long-term care insurance, hybrid and asset-based solutions, and self-funding strategies.

The bottom line: - Being able to pay for long-term care does not mean keeping all of the risk is the smartest financial choice.