Someone turning 65 today has almost a 70% chance of needing long-term care at some point. That's the number most families don't plan for. This guide answers the two questions behind it: how likely you are to need care and for how long, then what that care actually costs and who pays the bill.
Start with the odds. Then look at the price tables and the payers below.
Will You Even Need It?
Probably. Someone turning 65 today has almost a 70% chance of needing some type of long-term care in their remaining years. That figure comes from the federal Administration for Community Living, which runs LongTermCare.gov.
Long-term care means help with everyday activities: bathing, dressing, eating, getting around. It's not the same as the skilled medical care you get after surgery. Most of it is hands-on daily help, delivered at home, in assisted living, or in a nursing facility.
The odds split widely. About one-third of today's 65-year-olds may never need long-term care at all. At the other end, about 20% will need it for longer than 5 years. So this is not a small, predictable expense for most people. It's a coin-flip risk with a long tail.
How Long Does It Last?
On average, people need long-term care for about 3 years. But averages hide the spread, and they differ by sex. Women need care longer than men: 3.7 years on average versus 2.2 years for men. Women tend to live longer and more often outlive a spouse who could have cared for them, so they more often pay for paid care.
Most long-term care happens at home, not in a facility. About 35% of today's 65-year-olds will use a nursing facility at some point, and the typical stay there is around 1 year. The longer, multi-year care is more often delivered at home or in assisted living. The duration is what makes the math hard: a year is survivable for many budgets, five years is not.
So plan around two numbers, not one. The chance you'll need care at all is high, near 70%. The chance you'll need it for years rather than months is real but smaller, about 1 in 5. A plan that covers only a short stay leaves the expensive tail uncovered, and the expensive tail is exactly what bankrupts families.
What It Costs
These are national medians for 2026, from the Genworth/CareScout 2024 Cost of Care Survey, the most recent national data. Your state and metro area can run well above or below them. High-cost states sit far above the median; rural areas sit below.
| Care Type | Median Monthly Cost | Median Annual Cost |
|---|---|---|
| Adult day health care | about $2,000 - $2,167 | about $24,000 - $26,000 |
| Assisted living | about $5,900 | about $70,800 |
| Home health aide | about $6,483 | about $77,792 |
| Nursing home (semi-private room) | about $9,277 | about $111,325 |
| Nursing home (private room) | about $10,646 | about $127,750 |
Adult day health care is the cheapest option, close to $24,000 to $26,000 a year. A nursing home private room is the most expensive, at a national median near $127,750. Non-medical homemaker care runs close to the home health aide figure.
Now combine cost with duration. At about $9,277 a month, a single year in a semi-private nursing home room runs past $111,000. The 20% of people who need care for more than 5 years can spend well over half a million dollars before any program kicks in. And these costs are climbing faster than general inflation, commonly 1% to 12% a year by category. That combination is why most middle-class families end up combining payers rather than paying it all themselves.
The setting matters as much as the duration. A home health aide at a national median near $6,483 a month costs less than a semi-private nursing home room, but only if part-time hours are enough. Round-the-clock home care can cost more than a facility, because you're paying for the staff hours directly. Assisted living, at about $5,900 a month, sits in the middle and bundles housing with daily help. The cheapest workable option is the one that matches the actual level of care needed, not the lowest number on the table.
Match these national figures against your own area before you budget. A high-cost metro can run far above the median, and the same care in a rural county can run well below it. The table is a starting point, not a quote.
Who Pays
Here's the part that surprises people most: Medicare does not pay for most long-term care. Medicare covers skilled and rehabilitative care on a short-term basis, like a stay in a skilled nursing facility after a hospital discharge. It does not pay for the non-skilled, hands-on help with daily activities that makes up the majority of long-term care.
That leaves three main sources, and most families use more than one.
Out-of-pocket. Savings, Social Security income, pensions, and home equity. Most families start here. The risk is duration: at the costs above, savings drain fast over a multi-year stay.
Medicaid. For people who qualify financially, Medicaid is the single largest payer for long-term care in the country. It covers nursing home care and many in-home and assisted living services, but it's means-tested, so it covers people with limited income and assets. Many families reach it only after private savings run low.
Long-term care insurance and other tools. If your loved one bought a policy years ago, it pays toward home care, assisted living, or a nursing home up to a benefit limit. VA benefits, life insurance, and reverse mortgages fill gaps for some families.
These payers stack. A common path looks like this: private savings cover the first stretch, an old long-term care policy or VA benefit offsets part of the monthly bill, and Medicaid takes over once countable assets fall below the limit. The order matters for planning, because Medicaid reviews several years of past financial records, and moving money the wrong way can create a penalty period. The detail on each payer, who qualifies, and how to combine them legally is its own guide.
The federal consumer resource at LongTermCare.gov, run by the Administration for Community Living, and the planning data from HHS ASPE both confirm the same bottom line: Medicaid and out-of-pocket spending carry most of the long-term care bill, not Medicare.
For how each payer works in detail, who qualifies, and how to combine them, see our full guide on how to pay for senior care.
Frequently Asked Questions
Almost 70% if you're turning 65 today. About one-third of today's 65-year-olds may never need it, but 20% will need it for more than 5 years. Treat it as a real risk, not a rare one.
About 3 years on average, but it varies by sex. Women average 3.7 years, men 2.2 years. About 35% of people use a nursing facility, typically for around 1 year. Longer, multi-year care more often happens at home or in assisted living.
No, not for most of it. Medicare covers short-term skilled or rehabilitative care, like a limited nursing home stay after a hospital discharge. It does not pay for ongoing non-skilled help with daily activities, which is what most long-term care is. For that, families rely on Medicaid, insurance, or private pay.
A national median of about $111,325 for a semi-private room, or about $127,750 for a private room. That's roughly $9,277 to $10,646 a month. Your state and metro area can run well above or below those figures.
Adult day health care, at a national median near $24,000 to $26,000 a year. Assisted living runs about $70,800 a year, and a home health aide about $77,792. The right option depends on the level of care needed, not just the price.
Learn More
Find personalized help estimating your long-term care costs and coverage at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.