$100K would cover nursing home costs for anywhere from 9-18 months depending on where you are. With 20 years to (hopefully) grow it, it seems like you should be able to self-insure and get several years of coverage. The risk of course is that you need to be in a facility for a long time, but the average stay is something like 2.5 years IIRC, and only like 5 months if you move into a facility for end of life care.
What people sometimes forget, when planning for LTC, is that if they are in a facility or getting care at home, they are also not spending on travel (cruises, airfare, hotels), restaurant meals, fancy new automobiles, etc. Heck, Iâd probably be spending a lot less in a facility 
@notrichenough, does that 2.5 yrs average stay include assisted living, or nursing facility? Iâve read the average stay in a LTC facility is closer to 100 days, which is also the deductible on most current LTC policies. I may not be remembering correctly, though.
@hayden, the stats I saw didnât break it down.
[40 Must-Know Statistics About Long-Term Care](http://news.morningstar.com/articlenet/article.aspx?id=564139)
[What Is The Probability Youâll Need Long-Term Care ?](Long term care probability or the risk you'll need long term insurance)
[Length of Stay in Nursing Homes at the End of Life](Length of Stay in Nursing Homes at the End of Life)
It can be hard to decipher statistics. Perhaps the reason that wealthier and married people die sooner in nursing homes is because they have the support and money to stay home longer. Perhaps they enter the nursing homes when they are older and sicker.
@notrichenough, thanks. Thatâs very helpful.
Insurance, you have to jump through the hoops - proving to their satisfaction about documented loss of ADLs. Alzheimers/Dementia is an automatic qualification for the most part. So if you have insurance, you have to have someone making sure one has it appropriately paying. Even a âgoodâ company can try to keep their claims down - this happened with me on my private disability policy during debilitating stage III cancer treatment. I had to challenge them not wanting to cover.
I imagine if one has insurance, some of the statistics are better measure of the true need. Otherwise people delay as much as possible moving into varying levels of facilities while using care coming into their home, or even 24/7 care at home.
Post 7604 also has a true dimension - wealthy or heavily insured can afford varying levels of care w/o going into a nursing home/skilled care facility. If one has Medicaid and cannot live in own home/apt, and w/o family taking them in, there is no in-between care, and they go into a nursing home.
@SOSConcern, both of my parents had health problems at the same time â he had a stroke and she, I think because of the stress of taking care of my father after he returned from rehab, had Guillane-Barre syndrome. I hired someone to submit all of the bills to the insurance companies and to contest when they tried not to pay. I paid her a monthly fee, I believe and it was really worth it. Nice person as well. She caught all kinds of things that even a very smart person would not catch because they are health insurance nuances.
With respect to post 7604, I think that the hybrid product would probably pay for home care before nursing home as well as nursing home, so even though the visits are shorter, the expenses pre-nursing home need to be considered.
Agree @shawbridge about how some local health care professionals and elder care services (who are insurance savvy due to their experiences) know all the things to document and also what is appropriate to not only ask for with care but what is available.
I knew my disability policy provisions and what my medical oncologist had documented. Imagine being told no, and saying âwell I will have to discuss this with my attorneyâ had the next morning phone call with a âyesâ on disability payments, since they did a further review. And this was supposedly a decent company - really sad, because either I was going to get better or I was going to die - and their payments would end either way in not too distant future.
I got an email today from Fidelity that explained something called a Qualified Longevity Annuity Contract (QLAC). These things were only invented⊠I mean âcreatedâ by congress in 2014, so they are new. I have a little switch in my brain that turns off at the mention of the word, âannuityâ but this is something we should at least know about, because⊠apparently it is a device that lets you exclude some IRA (or 401k) money from the Minimum Required Distribution calculation, so if you are getting near age 70 1/2 and you donât think you will need all the money that you will be required to withdraw (RMD) at age 70.5 you can pust forward some of that money by purchasing an annutity⊠something like that. As I said, something new and worth looking into.
(I see from the search function dstark mentioned this - or at least provided a link - wayyyyy back in post #2826, so much ahead of me!)
Hereâs an article that talks about QLACs. There is a significant risk to buyer that s/he wonât recover the money spent to purchase the QLAC. You also need to be concerned about long term solvency of the insurer. There is a cap on how much can be spent purchasing a QLAC. I guess our IRAs are too smallâhavenât gotten notified about QLACs by anyone.
Shawbridge (or others): Where do you find people or organizations who can help wade through the insurance / medical bill nightmare? We had it relatively easy with my parents, but am more concerned about our own future. Itâs the last thing on your list as a patient, and I donât want my children to inherit that job. assuming it continues to get worse.
Iâd check with the Dept of Health, Executive Office on Aging in your area. They may be able to refer you. It may depend on what state you end up living inâyou may live closer to your kids than you do now.
For us, I expect the medical bills to be pretty straight forward. We have Medicare for H (and me when I get old enough) plus a good federal plan with a $2500/person cap.
@kjofkw, I think you can search for medical claims advocate or medical billing advocate. Here are three links I just found. http://medicalclaimsadvocates.com/, http://medicalinsuranceadvocacy.com/, and http://www.claims.org/. Alas, I looked up the person who helped us 10+ years ago and found an obituary.
Well, Iâm feeling slightly stupid.
Iâve known about tax loss harvesting (selling investments that have lost value in taxable accounts in order to capture the short-term or long-term capital loss) for a long time.
I know that you can offset gains with these losses. But, weâre generally buy-and-hold investors.
Somehow I never figured out tax gain harvesting â selling appreciated stock, offsetting the gains with losses from tax loss harvesting, and then re-buying the (appreciated) same number of shares of the stock moments later. (Wash sales do not apply if youâre re-buying stock which you sold at a gain.) It captures the gain at a zero tax rate, and the repurchase effectively increases the basis of the stock.
Why do it? Iâve been doing some planning ahead to retirement, and between RMDs, taxation on Social Security and Medicare, taking the gains now at 0% avoids some ugly marginal tax rates post-retirement.
So, $25K loss on ABC. 
Originally bought DEF at $10 a share. Now worth $60/share. Sold 500 shares for a gain of $25K.
Loss and gain wash.
Rebought DEF at the price I sold it. (It was a few pennies different, but pretty much a wash.) We like DEF.
If youâre in the 10% or 15% federal tax bracket, I think you can even take capital gains up until the top of the bracket and pay zero capital gains tax (federally).
Much earlier, I learned from this thread about mega-backdoor Roth IRAs? To fund that, one needs a 401k that allows post-tax as well as pre-tax contributions, correct? My 401k custodian does not allow that. Those of you with mega-backdoor Roth IRAs, which custodian do you use?
DW is no longer with that company, but it was a 401k done using Fidelity. Iâm not sure that the custodian matters as much as the company 401k plan.
Btw, DW misses her old office, some (very few) of her old colleagues, and the 401k that we only discovered had the mega feature late in the game. She got out in the nick of time.
Well, I have my own company, so I guess we have to figure out who to use as the company plan administrator. In her companyâs case, Fidelity as the plan administrator allowed it?
Are any of you using 529s as a device to pass on assets for your grandchildrenâs education? We have $$ left in both kidsâ 529 plans (though one may hit zero). I am thinking of funding each to the max for grandkids (though neither is married and only one has a SO at the moment). The only hitch, I suppose, is that one or the other might not have kids. Then there would be 10% penalty on withdrawals. But, if the accumulation were over 30+ years, that is probably OK.
They had previously used ADP, which also allowed post-tax contributions.
I donât think it matters much to them, although theyâd rather you didnât make in-service withdrawals. They made a small error in cutting the checks, so that we have a small 4 digit amount left in the post-tax account.
They just need to separately track contributions and returns in a sub-account. Itâs pretty easy for them, and (they figure) gives them more AUM.