System Working Papers 17-22

Old, Frail, and Uninsured: Accounting for Puzzles in the U.S. Long-Term Care Insurance Market

R. Anton Braun | Federal Reserve Bank of Atlanta
Karen A. Kopecky | Federal Reserve Bank of Atlanta
Tatyana Koreshkova | Concordia University and CIREQ

Published August 9, 2017

Half of U.S. 50-year-olds will experience a nursing home stay before they die, and a sizable fraction will incur out-of-pocket expenses in excess of$200,000. Surprisingly, only about 10 percent of individuals over age 62 have private long-term care insurance (LTCI), and many applicants are denied coverage by insurers because they are frail. This paper proposes an equilibrium optimal contracting framework that features demand-side frictions due to Medicaid and supply-side frictions due to adverse selection, market power and administrative costs of paying claims. We find that low LTCI take-up rates and rejections among poor individuals are due to Medicaid. Supply-side frictions, however, are responsible for rejections among frail affluent individuals, and both types of frictions matter for those in the middle class.

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