Who actually needs long-term care insurance?

It's most useful for the middle: people with enough assets to lose but not enough to comfortably self-fund years of care. If you have very little, Medicaid will eventually cover nursing-home care after you spend down. If you're genuinely wealthy — say, several million in liquid assets — you can self-insure and skip the premiums. In between is where long-term care insurance earns its keep, protecting a spouse's retirement and your kids' inheritance from being drained by a multi-year care event. Roughly 70% of people over 65 will need some long-term care, and costs run tens of thousands per year. Consider your family health history, whether a spouse would be left vulnerable, and whether you'd rather pay premiums or risk the assets. The sweet spot to buy is your mid-50s to early 60s, before health issues raise the price or make you uninsurable.