Watching the battle over health care legislation in Washington, D.C. is like watching a high-stakes ping pong match. First one side and then the other has the edge in votes, with the future of every American’s health care hanging in the balance. As of this writing it seems that the most recent Republican plan to repeal and replace the Affordable Care Act (a.k.a. Obamacare) has ended up in a legislative dead end, and now our political leaders have to go back to the drawing board. The future of American health care policy is as murky as ever.

But no matter which of many arguments eventually prevails, there’s a growing consensus among many that some major changes to the Medicaid program are probably inevitable – and those changes may have a significant impact on your decision about whether to purchase long-term care (LTC) insurance. That’s the conclusion from this article which appeared in the New York Times just a few days ago. We highly recommend you read this timely piece because it will help shed some light on one of the more important retirement-related decisions you’ll face: how will I cover the costs to care for myself when I can no longer live independently?

New York Times money columnist Ron Lieber writes that the outcome of the proposal to drastically cut Medicaid benefits is “important to nearly everyone, even people who are reasonably affluent.” He calls Medicaid the “backstop for retirees who run out of money but still need home-based care or must move into a nursing home.” As we’ve warned repeatedly on the AgingOptions radio program and in our LifePlanning Seminars, these long-term care costs (which are almost never covered by Medicare) can quickly add up to several hundreds of thousands of dollars, draining away the retirement savings of many middle class seniors who thought they had enough set aside.  The important thing to realize, Lieber suggests, is that even if the Republican health care plan with its built-in Medicaid cuts fails to move forward, something is going to have to give. In the words of the Bipartisan Policy Center in Washington, “States will not be able to sustain spending for long-term services and supports” as the baby boomers start needing care. Boomers with their meager retirement savings could bust the Medicaid budget.

The Times article suggests that all this talk of Medicaid cuts has revived interest in various forms of long-term care insurance. Originally LTC policies only covered nursing home residents, but in recent years home-care and assisted living have also come under the coverage umbrella for most policies. According to a 2015 study cited by Ron Lieber, just over half of those turning 65 will need some form of long-term care before they die. (This is lower than other studies which have pegged the total of those who will one day need long-term care at closer to 70 percent.) One-fourth or more, says the Times, will need less than two years’ worth of coverage while about 14 percent will require five years of coverage or more. The majority are somewhere in between.

But the irony is that even with a growing population of seniors needing coverage, the number of insurance companies offering that coverage is dropping rapidly, mostly because companies guessed wrong in the early years of writing LTC policies. They charged premiums that were too low and paid out benefits that cost more and lasted longer than they had anticipated. The result was a severe market shake-out, such that today only a handful of surviving firms remain, having learned a painful actuarial lesson the hard way. These days LTC premiums are significantly higher than they used to be, and underwriting standards are stricter. The New York Times says that many who apply won’t qualify: industry data reveals that 25 percent of applicants in their 60s were turned down for long-term care coverage, as were 44 percent of people in their 70s.

So with those daunting odds combined with high costs plus the uncertain odds you’ll ever need coverage someday, what’s the best decision? You could opt for a traditional long-term care policy. You could also investigate the growing number of life insurance policies being offered today that include a long-term care benefit: in return for a much higher initial premium, you have the peace of mind of knowing that your heirs will inherit the policy’s proceeds if you never need long-term care. Or you could trust your investment savvy, Lieber suggests, and hope you can save enough to cover the costs of your care should the need arise – costs which for a significant number of seniors will exceed $250,000.

It’s definitely a challenging decision. “There is no calculator that can size things up precisely,” writes Lieber. He recommends something we’ve often suggested here at AgingOptions: before investing in any form of LTC insurance, “hire an independent adviser on an hourly basis…to examine the policy side by side with traditional long-term care insurance and the possibility of paying for care out of pocket.”  Don’t rely on the advice from someone with a product to sell! If you’ll contact us at AgingOptions we can recommend some objective professional planners in your area whom you can approach with confidence.

One of the critical things to remember in all this, warns Rajiv Nagaich of AgingOptions, is that planning around Medicaid must start years before you ever need it. “Even if present laws remain unchanged,” says Rajiv, “we believe that Medicaid benefits are going to be harder to access in the future, not easier.” What’s more, Medicaid by itself is completely inadequate to ensure any real quality of life as you age. “It promises only life – not quality,” in Rajiv’s words.   The best strategy – one that the professionals at AgingOptions can help you implement – is to learn how to safely set aside funds today so you can augment the care you receive from Medicaid in the future. A LifePlanning Seminar is a great next step for you.

Lieber’s article ends with the suggestion that maybe, considering the extent of the looming long-term care crisis in the U.S., our political leaders will come to see that a comprehensive solution involving expanded Medicare benefits for the care needs of aging seniors is necessary. Sadly, while this may be a worthy dream, the present dismal state of bi-partisan political discourse in America leaves us pessimistic. Instead of waiting around for the government to come up with a solution, we recommend you find a terrific solution for yourself in the form of a LifePlan from AgingOptions. Your LifePlan contains all the planning elements you’ll require for a secure retirement future: a financial plan, a legal strategy, a comprehensive medical safety net, and a well-planned strategy for your housing needs – all combined with a plan to involve your family at every stage of retirement. We invite you to come find out more about all aspects of retirement planning by attending a free LifePlanning Seminar near you.

Simply click here for details and online registration, or call us during the week. Let AgingOptions help guide you into the retirement you’ve always hoped for!

(originally reported at www.nytimes.com)