# Long-term care insurance within married couples: Can’t insure one without the other?

## TL;DR

This paper explores how decision-making power within married couples affects the purchase of long-term care insurance, finding that women with more power are more likely to be insured.

## Contribution

The study introduces intra-household bargaining power as a novel explanation for low long-term care insurance take-up.

## Key findings

- Couples are equally likely to purchase LTCI for the woman, the man, or both.
- Women with more bargaining power are more likely to be covered by LTCI.
- LTCI take-up is higher in couples where women have more decision-making power.

## Abstract

Although long-term care remains one of the largest uninsured risks facing older Americans, demand for insurance remains low. While there is a long literature estimating a variety of factors that contribute to this low demand, much of it has overlooked the fact that most private long-term care insurance (LTCI) purchases are made within couples, adding a host of additional reasons for low demand. This paper examines the role of financial decision-making power within the couple and the association with LTCI purchase decisions. We document LTCI purchase patterns among married couples and find that, among couples who ever purchase LTCI, they are roughly equally likely to purchase for the woman exclusively (10.0%), the man exclusively (11%), or both (11%). However, among couples where women have more bargaining power, LTCI purchases are more likely overall (40% vs. 33%), and more likely to cover the woman, either exclusively (16% vs. 11%) or as part of both members of the couple (14% vs. 11%), than among couples with more traditional gender roles. In adjusted analyses, we find that women are more likely to be insured when they have more bargaining power. These findings suggest that intra-household bargaining power may be another potential explanation for the particularly low LTCI take-up, especially in the time period in which policies were unisex-priced.