It’s a pretty good bet that if you read a daily newspaper (some of us still do!) you’ll see at least one scare article per week about how much health care is going to cost you in retirement. Now, these articles have always mystified me, because almost anyone who can afford it is purchasing “medigap” insurance, and anyone who isn’t probably doesn’t have enough money to be worth collecting against. Agreed, there’s a lot of stuff Medicare doesn’t cover, but the medigap stuff, IMHO, has been pretty good.

Of course, there are some things that medigap doesn’t cover either—extensive therapy, experimental treatments, and drugs. Many people find that they slip through the “donut hole” in the Part D drug program, especially if they select a program based on what drugs they’re taking, and then the doctor decides to switch a prescription or they develop a new and uncovered need for a specific drug. However, the specific program can be switched next year. So, where are these huge estimates coming from?

As far as I can tell, most of these projection type studies assume that the cost of these various insurances will inflate over the years. But I don’t see many people having a specific fund or savings program for health care costs—we tend to pay these things (just like a great part of college tuition) from current income. Certainly, the cost of health care should be factored into your overall budget, and just like everything else, you can expect it to inflate.

But where do the really huge numbers come into play? Long-term care. And despite what a distressing amount of people seem to believe, Medicare does NOT pay for long term care. Medicare will pay for 100 days of long term care provided you have been hospitalized for THREE days, and provided you can be certified as continuing to make progress. And boy does the medical system work those qualifications! You have to fight tooth and nail to be kept in a hospital for three days—when my father landed in the hospital while I was out of town (bed-ridden, with pneumonia, and semi-incoherent) I received a call saying that they were releasing him in two days. Since I was out of town and had no way to find a placement for him, I told them they’d have to park him in the lobby. When I arrived at his bedside right from the airport, I was told that he, and only he, could make a direct appeal to Medicare. I’m still not clear exactly what that procedure was, but he was given a phone number and while I watched him gasp out answers, he apparently demonstrated enough illness and incoherence that they kept him another two days.

Fast forward—we placed him in a nursing home. For 100 days at Medicare’s expense? Nope—he collapsed at the “physical therapy” sessions, had to be lifted onto a gurney by three people, and because he was “refusing” to go to therapy (since he couldn’t even turn over), he was no longer eligible for Medicare coverage for the nursing care. Moral: don’t count on Medicare AT ALL for so-called custodial care.

Long term care insurance is expensive, but for most people, paying for that insurance for 20 years isn’t as expensive as one year in skilled nursing care. In this neck of the woods, a semi-private room will cost $275-$300 x 365 days = or somewhere north of $100,000 per year. But that’s not the end of it—every aspirin, mouthwash, or bit of shampoo you consume will also be added on, at nursing home prices.  Compare that to $3,500 for 20 years = $70,000. And what about if you live for several years needing skilled care?—believe me, when you need it you really need it. For some reason, people hate the thought that they might pay for It and never use it. I say, do you have homeowner’s insurance? What’s the likelihood that your house will ever burn down?

So why is it a women’s issue? Well, every single article you see always estimates health care for the elderly as costing more for women—we simply live longer, and that means significantly more costs. But, there’s more.

You may think you have enough assets to cover the cost of nursing care. There’s the side problem that your kids will be thinking about how you’re burning up their inheritance, but maybe you don’t care about that. For couples, though, there’s a sad and ignored scenario. The usually older husband ends up needing care. The elderly wife takes care of him as long as she can, but she’s elderly too, and there’s a serious cost to her own health and well-being, as anyone who has ever done this will attest.

Finally, he ends up in a nursing home, but now a huge amount of their assets, and all his Social Security, are going to pay for costs of care. Yet, except for food, her expenses at home are probably not going down. It’s stunning to see how fast the retirement fund will need to be liquidated. Finally, he passes on and she’s left with 1/3 less Social Security, far less assets, and probably much poorer health. Who’s going to take care of her? When she needs long term care, will there be anything left?

Oh, perhaps you think your children will care for you. Me, too. But having also been a daughter in that position, I can attest that it is much better to be a care manager than a care provider. Even with long-term care funds, your children will be exhausted from all the doctor’s appointments, midnight calls, and rocket rides to the emergency room. I don’t want my daughter cleaning me up, lifting me, and even more unspeakable tasks. I want someone who has professional training, knows what they’re doing and can properly use assistive equipment. And statistics say that it almost always is the daughter, or the daughter-in-law, to whom care-giving falls. One of the consequences of modern medicine is that far more of us are likely to spend an extended time as very frail and very elderly.

If you love your spouse and care about your children, you’ll get long term care insurance. If you as a couple can only afford the premium for one, make it the woman—she’s way more likely to collect on it.