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

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Listed:
  • R. Anton Braun
  • Karen A. Kopecky
  • Tatyana Koreshkova

Abstract

Half of U.S. 50-year-olds will experience a nursing home stay before they die, and one in ten will incur out-of-pocket long-term care expenses in excess of $200,000. Surprisingly, only about 10% of individuals over age 62 have private long-term care insurance (LTCI). This paper proposes a quantitative equilibrium optimal contracting model of the LTCI market that features screening along the extensive margin. Frail and/or poor risk groups are ordered a single contract of no insurance that we refer to as a rejection. According to our model, rejections are the main reason that LTCI take-up rates are low. Both supply-side frictions due to private information and administrative costs and demand-side frictions due to Medicaid play important and distinct roles in generating rejections and the pattern of low take-up rates in the data.

Suggested Citation

  • R. Anton Braun & Karen A. Kopecky & Tatyana Koreshkova, 2017. "Old, Frail, and Uninsured: Accounting for Puzzles in the U.S. Long-Term Care Insurance Market," FRB Atlanta Working Paper 2017-3, Federal Reserve Bank of Atlanta.
    • Handle: RePEc:fip:fedawp:2017-03
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    References listed on IDEAS

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    Cited by:

    1. Radim Bohácek & Jesús Bueren & Laura Crespo & Pedro Mira & Josep Pijoan-Mas, 2018. "Inequality in Life Expectancies across Europe," Working Papers wp2018_1810, CEMFI.
    2. Dante Amengual & Jesús Bueren & Julio A. Crego, 2021. "Endogenous health groups and heterogeneous dynamics of the elderly," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 36(7), pages 878-897, November.
    3. Amengual, D.; Bueren, J.; Crego, J.A.;, 2017. "Endogenous Health Groups and Heterogeneous Dynamics of the Elderly," Health, Econometrics and Data Group (HEDG) Working Papers 17/18, HEDG, c/o Department of Economics, University of York.
    4. Eric French & John Bailey Jones & Elaine Kelly & Jeremy McCauley, 2018. "End-of-Life Medical Expenses," Working Paper 18-18, Federal Reserve Bank of Richmond.

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    More about this item

    Keywords

    long-term care insurance; Medicaid; adverse selection; insurance rejections;
    All these keywords.

    JEL classification:

    • D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
    • D91 - Microeconomics - - Micro-Based Behavioral Economics - - - Role and Effects of Psychological, Emotional, Social, and Cognitive Factors on Decision Making
    • E62 - Macroeconomics and Monetary Economics - - Macroeconomic Policy, Macroeconomic Aspects of Public Finance, and General Outlook - - - Fiscal Policy; Modern Monetary Theory
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • H30 - Public Economics - - Fiscal Policies and Behavior of Economic Agents - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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