Dying is expensive in America. Healthcare expenditures from all payors (public and private) total $80,000 in the last 12 months of life and $155,000 in the last 3 years. Although most end-of-life expenses are paid by insurers such as Medicare and Medicaid, the amount households pay out-of-pocket is hardly trivial. Furthermore, some conditions, such as dementia, are not well insured, leaving families with potentially enormous liabilities. In this viewpoint, we discuss the current funding of end-of-life care in the US. We argue that long term care (LTC) expenses are underinsured relative too other types of late in life care, such as hospitals pending and doctor visits. We then discuss potential reforms that would better insure families against catastrophic expenses related to LTC.