If One of You Needs Care, Will the Other Be All Right?
By Jeffrey Meenes, CFP®
Frank’s father needed care for the last five years of his life. Frank remembers the facility, the paperwork, the visits. But when he talks about it now, he talks about his mother.
She lived eleven more years after his father died. The bills had been paid, and the house was still hers. But she was left with fewer choices than she had expected to have — and she spent those years being careful in ways she hadn’t planned on.
So when Frank and Ellen, 67 and 64, sat down to talk about long-term care, the question Frank asked wasn’t whether they could afford it.
It was: if one of us needs it, will the other one be all right?
The Choice That Isn’t Really the Choice
Most people come to this decision with two options in mind. Buy a policy large enough to cover whatever happens, or trust the savings and carry the risk yourself.
Both are reasonable instincts. The first feels responsible. The second feels confident, and for a household with real assets it’s often defensible. But neither one answers the question Frank actually asked. The first answers how do we pay for care? The second answers can we afford it? Frank wanted to know what would be left for Ellen.
That’s a different question, and it leads to a different decision.
The Risk Isn’t One Thing
“Long-term care” sounds like a single event with a single price. It isn’t. It’s a range of possibilities, and they don’t affect a household the same way.
A shorter care need may be manageable from savings, depending on the services required and the household’s resources. The more consequential question is what happens when care continues for years.
A long care need is different. Its financial impact depends not only on how long it lasts, but on when it occurs and what the other spouse will still need from the portfolio. A long need for one spouse while the other still has decades to live is the version that reshapes a retirement. The money that pays for care is the money the other person was going to live on.
Care at home isn’t free either, even when no one sends a bill. When one spouse cares for the other, the cost is paid in the caregiver’s time, energy, and often health — and it falls on exactly the person the plan is supposed to protect. Treating that care as free, or assuming a spouse can provide it indefinitely, can cause a household to underestimate its risk.
And the household’s situation changes over time. If one spouse needs care and later dies, the one who remains may eventually need care too — often without anyone at home to help.
None of this says how much insurance any particular couple needs. It says the question is less “do we insure long-term care?” than “which of these outcomes could we absorb, and which would change the life of the person who’s left?”
What Frank and Ellen Worked Out
For Frank and Ellen, the answer came in pieces.
Their resources could absorb a shorter care need, for either of them, without materially changing their long-term plan.
What the plan couldn’t carry well was a long care need for Frank in his seventies, while Ellen was healthy and expected to live another twenty years. In that version, the cost of his care came straight out of the income and assets she’d be relying on — the same outcome Frank remembered from his mother.
That scenario made the risk concrete. It also told them what they were trying to protect: not every possible care cost, but the plan Ellen would live on — and, if the order were reversed, the one Frank would.
They took that answer to a licensed insurance professional — the problem first, the product second. A policy doesn’t pay because a particular scenario happens; it pays according to its own terms. So the question wasn’t which policy was best in general. It was whether any coverage, on terms they were comfortable with, would meaningfully protect the spouse who remained.
For them, the answer was yes, at a level smaller than the comprehensive policy they had first been shown. The coverage didn’t need to pay for every year of every possible care need. It needed to carry enough of a long one that the rest could come from the portfolio without materially compromising the retirement Ellen had planned on — or Frank’s, if it were Ellen who needed care. Some of the risk stayed with the portfolio, by design. The aim was coverage that left a cost the plan could absorb, not one that would reshape it.
They also wrote down what would happen if care were ever needed — which accounts would pay first, when the coverage would begin, and which money would stay untouched for whoever remained. Ellen keeps that page.
Other Households Land Elsewhere
Frank and Ellen’s answer was right for them. It isn’t a formula.
Some households have enough that a long care need, even for the first spouse, wouldn’t meaningfully change the other’s life. For them, carrying the risk may be the sound choice, and paying premiums for decades would buy little they need.
Some households find that the coverage that would protect them costs more than the protection is worth, or comes with terms they aren’t comfortable with. They may decide to carry the risk deliberately and plan around it.
And some households, once they look closely, find that the risk they can’t absorb is larger than they thought. For them, substantial coverage is the responsible answer.
What these households have in common isn’t the outcome. It’s that they decided based on what the coverage was for, rather than on how much of it was available.
Why This Is Hard to Sort Out Alone
Each part of this is answerable on its own. The difficulty is that they interact.
How much risk you can carry depends on what your income looks like in your seventies and eighties. That depends on Social Security decisions, on how your accounts are drawn down, and on taxes that change depending on which account pays for what. The cost of care affects the survivor’s income, which affects what they need from the portfolio, which affects what the household could have afforded to insure in the first place. And the insurance itself is a long commitment, made in your sixties, for a need that may come in your eighties.
That’s why the insurance question comes last, not first. Decide what you’re protecting. Then decide whether, and how much, insurance is the right way to protect it.
Frank’s question had an answer after all. It just wasn’t a policy.
It was a plan for the spouse who might never need care, as much as for the one who might.
Frequently Asked Questions
Doesn’t Medicare cover long-term care? Generally not. Medicare covers some short-term skilled care under specific conditions, but not ongoing custodial care — help with daily living over months or years, which is what much long-term care involves. That gap is why the decision matters.
Is it smarter to self-fund? Sometimes. For households with substantial assets, carrying the risk can be entirely reasonable. The test isn’t whether you could pay for care. It’s whether paying for it would change the other spouse’s life in ways you aren’t willing to accept.
When should a couple think about this? Earlier than most do. Coverage generally costs more, and can become harder to qualify for, as health changes with age. That doesn’t make buying earlier automatically better — cost, eligibility, policy terms, and what the protection is worth all matter. It means the decision is worth making deliberately while all the options are still available.
What should I ask an insurance professional? Start with what you want the coverage to accomplish, not with a product. The clearer you are about the specific outcome you’re protecting against, the easier it is to judge whether a particular policy, benefit structure, and premium makes sense — including whether premiums can change over time.
How does this fit with the rest of a retirement plan? Closely. How care would be paid for affects which accounts get drawn down, the taxes on those withdrawals, and what’s left for the surviving spouse. Long-term care isn’t a separate decision so much as one of the scenarios a retirement plan has to hold up under.
If you’re approaching retirement and want clarity around the decisions ahead, schedule an introductory call.
About the Author
Jeffrey Meenes, CFP®, is the founder of Meenes Wealth Partners, a fee-only, flat-fee fiduciary RIA in Shrewsbury, Massachusetts. He helps pre-retirees and retirees navigate the financial decisions surrounding the transition into and through retirement, with a focus on tax planning, retirement income strategy, and evidence-based investment management.
This content is developed from sources believed to be providing accurate information and provided by Meenes Wealth Partners. It may not be used to avoid any federal tax penalties. Please consult legal or tax professionals for specific information regarding your situation. The opinions expressed and material provided are for general information and should not be considered a solicitation for the purchase or sale of any security.