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Most Americans will eventually need long-term care, which is often expensive and not usually covered by public programs until recipients have nearly exhausted their savings. In 2009, 5.2 million Americans age 65 and older not living in institutions had long-term care needs. Yet, only about 1 in 10 Americans age 55 and older had private long-term care insurance in 2008. Coverage rates were nearly twice as high among those with annual incomes in excess of $100,000. Private insurance covered only 7 percent of the $240 billion in U.S. long-term care costs in 2009. Nearly a fifth were paid out of pocket.