Premiums for the program would be automatically deducted from the paychecks of people who work for participating employers, but employees would have the choice to opt out. Payouts would go only to those who had paid premiums for at least five years.

The long-term care program is in the House bill. But it is not yet clear if it will be in the Senate bill being shaped by Majority Leader Harry Reid of Nevada. Democratic centrists such as Budget Committee Chairman Sen. Kent Conrad of North Dakota have warned the program could add to the deficit. Proponents say it would fund itself.

Leaders of the Senate health committee are pushing for the program partly as a legacy of the panel’s former chairman, the late Sen. Edward Kennedy of Massachusetts. The Obama administration has endorsed it.

The program is meant to help address a looming problem in the U.S., where relatively few people have long-term care insurance to cover expenses if they need home care or a nursing home. Currently, the main federal resource for such coverage is Medicaid, which applies mainly to the poor. Medicare, the federal health program that covers the elderly, doesn’t include a long-term care benefit.

Long-term care is a concern for Kirby Tepper, 51, a psychotherapist in Los Angeles. Mr. Tepper bought a long-term care policy five years ago, after such coverage helped pay for the care of his ailing father. Mr. Tepper, a single cancer survivor who has Type 1 diabetes, pays $240 a month for a policy that would cover about five years in a nursing home. He would be interested in an additional federal program, he said, if “it’s a small premium that increases my benefits. “But he said he wouldn’t relinquish his current policy, which he sees as a safety net.

This year, average nursing-home costs for a semiprivate room are $198 a day, while hourly rates for home health aides are $21, according to a survey from MetLife Inc.’s Mature Market Institute.

The federal program would pay at least $50 a day, with the amount calibrated by the disability of recipients. People would be eligible if they couldn’t perform two or more daily activities, such as eating or bathing on their own. The benefit would continue until they recovered or died. Premiums would be set by the government to keep the program solvent.

The Congressional Budget Office, in an analysis of the program, assumed average monthly premiums of $123, and a typical daily benefit of $75. The office projected that the long-term care program in the House bill would be in the black by $72 billion in its first 10 years, and by a smaller amount in the following decade once more people started getting payouts. After 2029, it would start increasing the federal deficit, the CBO said, but its budget impact would be “fairly small” compared with other provisions of the bill.

However, Sen. Conrad and six other Democratic centrists expressed concern about “large, long-term spending increases that far exceed revenues.”

“It is unsustainable,” said Frank Keating, the former Oklahoma governor who is chief executive of the American Council of Life Insurers. The lobbying group, which has members that sell long-term care insurance, points to an analysis by the American Academy of Actuaries that said the program would likely draw a heavy proportion of participants with health conditions, while healthier people opted out.

The program’s backers say the legislation would require it to be “actuarially sound.” To assuage budget concerns, the version in a Senate bill could include new language barring taxpayer money from being used to fund the benefit.

Rep. John Dingell, the Michigan Democrat who was one of the members who added the long-term care program to the House bill, said he wasn’t concerned that young people would opt out of it. By joining at a younger age, bill supporters say, younger workers could lock in lower premiums, which rise with age and are also likely to go up over time to track the benefit’s inflation-pegged growth.

John Rother, executive vice president of AARP, which supports the long-term care program, said the benefit would be “enough to pay for the kind of care most people need.”

The Center for Retirement Research recently reported that 64% of pre-retirees will be at risk of not having enough money saved to maintain their current lifestyles. That means that 2 in 3 retirees will have to reduce their standard of living in retirement.

If no major medical issues arise, it may not be so bad. But we are living longer, and with that comes an increased chance of needing some sort of long term care. Unfortunately, most couples are not financially prepared for paying that type of expense out of pocket. Here are four reasons to consider buying long term care insurance:

It is easier to buy it when you are young

It may be hard to try to justify the expenses when we are in our 40s and 50s and nothing is wrong. But we must consider that we may not be able to buy it if we wait too long.

Our health is better when we are younger. According to the American Association for Long Term Care Insurance, about 70% of applicants ages 45 to 54 are accepted. However, acceptance drops to less than 40% for applicants between the ages of 65 and 74.

There is also a big jump in the cost as we get older. The annual cost of a policy for a 65 year old is double that of the cost for a 55 year old.

You never know if you will actually need it

We all think we will be healthy and never find ourselves in a long term care facility. But how realistic is that? Studies show that almost half of us will need some form of long term care during our lives.

Those odds are much greater than the chances of being in a car accident or losing our home in a fire. Yet, most of us have car insurance and a homeowner’s policy.

A stroke can trigger long term care benefits. According to the American Stroke Association, a stroke is a leading cause of serious, long term disability. About one-third of stroke victims are permanently disabled.

What is more startling is that almost one third of stroke victims are under the age of 65. That means that this group of individuals was not able to finish funding their retirement accounts before they were taken out of the workforce.

Your family may not be able to help

The average cost of long term care is about $75,000 per year. Statistics show that one in five of us will need care for at least one year. About 3% of us will need care for more than five years.

The American Association for Long Term Care Insurance was found that the average Alzheimer’s patient needs care for eight years.

Even if you bought a policy that costs $100 per month, your total lifetime out-of-pocket expense for the policy is less than the cost for one year of long term care. Which financial risk would you rather take?

Let’s also consider this from a physical care standpoint. Many of us assume that our family members will take care of us when the need arises. However, can we really expect our spouse or children to give up their careers and sacrifice time with their families to take care of us full time?

Will our spouses even outlive us, let alone be physically capable of caring for us? Would they be able to lift us, if necessary, to move us or to bathe us?

Will our children relocate themselves and their families to be available to us full time? What impact would that have on them financially?

What about government assistance?

Medicare will not pay for long term care. Certain types of health care may be covered, if you qualify, but long term care would still be necessary to help with basic supportive services for activities of daily living, such as dressing and bathing.

There are resources available through Medicaid, but you will need to be able to qualify. This means you have low income and few assets. You may also be limited to selecting from a few providers.

Long term care insurance is designed to ensure that you are able to have access to adequate assistance during years where you are less able to care for yourself. When considering the options, it may be a small price to pay to have more control over your care in those most critical times.