Long-term care planning
You should not have to. These are the published national medians for 2025. Move the dial to see the same care at the age you are more likely to need it, and then we can talk about how to pay for it without taking apart everything you have spent your life building.
2025Published medians
A paid caregiver, 44 hours a week. Less when family covers some of them.
A private one-bedroom apartment with care on site
Semi-private, skilled nursing
Private, skilled nursing
Projected at 3% a year, the same rate most long-term care policies use for their inflation protection.
Source: CareScout 2025 Cost of Care Survey (Genworth). These are national medians. Care costs vary widely by state and by metro area, with California and the Northeast running above these figures and much of the South and Midwest below, so treat them as a starting point rather than a local quote. Anything past 2025 is a projection at 3% a year, not a price.
What it is
The name makes people picture a hospital. It is closer to the opposite. Long-term care is the help someone needs with ordinary things once they can no longer manage them alone: bathing, dressing, eating, getting to the bathroom, and getting in and out of a bed or a chair. It is also the supervision someone needs when memory loss makes it unsafe to be on their own.
It happens in the three places priced above. Most of it begins at home, moves to assisted living when the hours get long, and reaches a nursing home only when the care has to be skilled and around the clock. Plenty of people never get past the first one.
A policy starts paying when a licensed professional certifies that you need help with at least two of those daily activities and are expected to for at least ninety days, or that a cognitive impairment makes it unsafe for you to be alone. That is the standard on tax-qualified policies, which is very nearly all of them, and it is worth understanding before you need it rather than after.
The odds
Half of the people turning 65 today are expected to require long-term care.
U.S. Department of Health and Human Services
Fewer than half of people over 65 have set aside any money to pay for it.
2022 KFF Survey on the Affordability of Long-Term Care
By 2029, 54% of seniors will not have enough financial resources to pay for long-term care.
Health Affairs
By 2050, the number of Americans who require long-term care will more than double.
Centers for Medicare and Medicaid Services
The part people get wrong
Almost everyone assumes it is covered. It is not. Here is exactly what it pays for and what it leaves you, while there is still time to plan around it.
Up to 100 days of skilled nursing care, and only after a qualifying inpatient hospital stay. The first 20 days are paid in full. Days 21 through 100 carry a daily coinsurance. After day 100 it pays nothing.
Medicare pays for conditions you are expected to recover from. It does not pay for a chronic illness and it does not pay for long-term cognitive decline, which is where a great many claims come from. It does not pay for custodial care either, meaning help with bathing, dressing, eating and getting around. That is not a footnote. That is most of what long-term care actually is.
Medicaid does pay for long-term care, but only after your assets have been spent down to your state’s limit. Nobody picks Medicaid at the start. It is what is left once everything else is gone.
The question worth sitting with
If you were to get sick tomorrow, other than liquidating your assets, relying on your children, or seeking government assistance, do you have any other plan to pay for your care?
Liquidate what you own, lean on your family, or move the risk to a carrier. Medicaid is the fourth answer, and it only starts once the first one has run out. Everyone ends up on one of these. The question is whether you picked yours on purpose.
(and potentially drain your assets)
Pay out of savings and investments. It works right up until it does not. Every dollar that goes to care is a dollar that stops earning, stops supporting the spouse who is still at home, and stops passing on to the people you meant it for.
(and hand them the job)
A daughter cuts back to part time. A spouse becomes a caregiver at seventy-four. It costs nothing on paper and a great deal everywhere else.
(and keep what you built)
A long-term care policy, or a life policy with a long-term care rider that pays out either way. You trade a known annual premium for an unknown six-figure bill, and what you own stays where you meant it to go.
This is the conversation I have with people.
How people buy it
They answer the same problem in different ways. Which one fits usually comes down to how you feel about paying for something you might never use.
(the original)
You pay an annual premium and the policy pays for care. Dollar for dollar it buys more care than the other two. The trade is that if you never need care the premiums do not come back, and the carrier can raise them across a whole class of policyholders.
(it pays either way)
A life insurance policy with long-term care built into it. Use it for care and it pays for care. Never need care and it pays your family a death benefit instead. Nothing is spent on a maybe, which is the exact objection this product was built to answer. It costs more per dollar of care.
(for money already set aside)
An annuity that pays out a multiple of its value if you need care. It suits someone with money already parked for a rainy day who would rather it did more than sit there, and the health questions are usually the lightest of the three.
Who it is for
The person it fits best has something to protect. Assets built over a working life, and a clear wish not to hand the family the job of managing a long illness on top of the heartache that already comes with one. If a long stretch of care would not meaningfully change your finances or your family’s, you may not need a policy at all, and I will tell you that.
The timing is the less comfortable half. Long-term care is medically underwritten, so the answer depends on your health on the day you apply, not on the day you need care. Someone who is already ill can be declined outright, or offered a premium they cannot afford. That is the whole reason this is a conversation people have in their fifties and sixties rather than in their seventies.
The mechanics
Two questions that rarely come up until somebody is already filing, and both are easier to weigh while you are still choosing a policy.
Some policies settle straight with the facility or the home care agency. You approve the care, the bill goes to the carrier, and nothing has to move through your own account first.
The most common arrangement. You pay for care, send in the documentation, and the policy pays you back up to your daily or monthly benefit. It means keeping receipts, and it means the policy pays only for what you actually spent.
An indemnity benefit pays the full amount once you qualify, for any reason, with no receipts to file. You can use it to pay a daughter who cut back her hours to help. It is the most flexible of the three and it usually costs the most.
Benefits from a tax-qualified policy are generally received free of income tax, and cash benefits are tax free up to a daily limit the IRS resets each year. Premiums on a traditional policy count as a medical expense within an age-based annual cap, and only help if you itemize and clear the threshold, though a business owner is often treated better than an individual. Hybrid premiums generally are not deductible. This is general information rather than tax advice, so run your own situation past your accountant.
About
I am independent. No carrier owns my desk, which means I can put three or four of them side by side and show you the difference rather than defending one.
I have had my own experience with long-term care. My wife has Parkinson's disease. I wish I had bought long-term care insurance. That is what made me look into this coverage and understand its value.
I write long-term care in 15 states and life insurance in 30, and I add states as new appointments come through, so it is worth asking even if yours is not on the list yet. There is no charge to talk to me and no charge to get a comparison. The carrier pays me if you buy something, and if nothing on the market is right for you I will say so.
Life insurance in all 30 states below. The 15 marked LTC are the ones I write long-term care in today.
Almost everyone wants to be looked after at home. It is often the least expensive option too, especially when family fills in some of the hours. The rest of those hours still have to be paid for.
No forms, no medical questions, no quote until you ask for one. We work out whether this is even worth your time, and if it is not, that is a perfectly good outcome.