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Like clockwork, Sara and James Cook paid $452 a month for life insurance. Around the world, life insurers are wrestling with existential questions. In particular, companies that sell policies that run for decades, like life and long-term care insurance, face a twofold challenge: how to fund policies that were sold back when their actuaries couldn’t envision a world of interest rates below 8 percent, and what to sell now, when those same actuaries can’t envision an appreciable rise in rates anytime soon.

People who bought universal life policies in the 1980s and 1990s — some of which guaranteed annual returns of 4 percent or more — are seeing their premiums soar.

Low interest rates are a big part of this new pressure on insurers; their earnings are being squeezed.