US Long-Term Care Cost Calculator — 2025
How much will long-term care really cost — and how long will your savings last?
Estimate the monthly and annual cost of nursing home, assisted living, home care, or memory care in your state. Model Medicare’s limited coverage, Medicaid spend-down, long-term care insurance offset, and see how long your assets will last before qualifying for Medicaid.
Estimates only. State Medicaid rules and costs vary widely. Consult an elder-law attorney or financial planner before relying on these figures.
How long-term care is paid for in the US
The four funding sources
US long-term care is funded from four sources, typically in this order:
- Medicare covers up to 100 days of skilled nursing after a qualifying 3-day inpatient hospital stay. Days 1-20 fully paid; days 21-100 have a $204/day co-pay (2024). Medicare does not cover custodial care, assisted living, or long-term stays.
- Private pay covers the bulk of care for most families — out of savings, retirement accounts, home equity, pensions, and Social Security.
- Long-term care insurance pays a daily or monthly benefit for up to a specified period (3 years, 5 years, lifetime). Requires an elimination period (usually 90 days) before benefits start.
- Medicaid kicks in after you’ve spent down to your state’s asset limit — typically $2,000 in countable assets for a single applicant. Primary home equity is usually exempt.
Typical cost progression
A typical path: 3-day hospital stay → 20-30 days Medicare-covered rehab → transition to long-term nursing care (private pay) → spend-down to Medicaid eligibility → Medicaid coverage. Middle-wealth families ($300k-$2M) typically spend 2-5 years private-paying before qualifying for Medicaid.
2024 Genworth median costs (nationally)
| Care type | Monthly | Annual |
|---|---|---|
| Home health aide | $6,292 | $75,504 |
| Homemaker services | $6,074 | $72,888 |
| Adult day health care | $2,167 | $26,000 |
| Assisted living facility | $5,350 | $64,200 |
| Memory care unit | $7,899 | $94,788 |
| Nursing home (semi-private) | $8,929 | $107,146 |
| Nursing home (private room) | $9,733 | $116,796 |
Costs vary hugely by state. Alaska tops $30,000/mo for nursing home care; Louisiana and Texas come in below $6,000/mo. Genworth publishes state-by-state figures annually.
The care continuum — from home care to skilled nursing
In-home care
A home health aide provides hands-on assistance with activities of daily living (bathing, dressing, transfers). Covered by Medicare briefly (if medically necessary post-hospitalization) but not for long-term needs. Most families pay privately or self-fund from children’s time. Cost: ~$30-35/hr.
Adult day care
Daytime supervision and activities (6-8 hrs/day) at a facility. Cheapest formal option at ~$2,200/month. Good bridge for caregiver respite. Often includes meals, medication management, and light medical care.
Assisted living
Private apartment or shared room in a facility with communal meals and some help with ADLs. Does NOT include skilled nursing — residents must be able to manage with minimal medical care. Medicare doesn’t cover it. Medicaid waiver programs cover it in some states.
Memory care
Specialist assisted living for dementia/Alzheimer’s, with secured environment and trained staff. Typically 30-50% more than standard assisted living.
Nursing home / SNF
24-hour skilled nursing care. The most expensive option but medically necessary for many. Medicare covers first 100 days after qualifying hospital stay. Medicaid is the primary long-term payer — about 62% of US nursing home residents are on Medicaid.
How Medicaid nursing home coverage works — asset limits and lookback rules
Asset and income limits
Medicaid is need-based. Federal guidelines set by state:
- Individual applicant: Countable assets ≤ $2,000 (most states)
- Married, one spouse needing care: Community Spouse Resource Allowance up to $154,140 (2024) — the at-home spouse retains this without jeopardizing the applicant’s eligibility
- Monthly income: State limits typically around $2,829/month; “Miller trusts” used to qualify when income exceeds limit
Exempt assets (not counted)
- Primary home — generally exempt, with equity cap of $713,000-$1,071,000 depending on state
- One vehicle
- Personal belongings and household goods
- Prepaid funeral/burial (generally up to $15,000)
- Life insurance with face value under $1,500
The 5-year lookback
When you apply for Medicaid, the state reviews all asset transfers in the prior 5 years (60 months). Gifts or below-market transfers trigger a penalty period — a disqualification measured as: Transferred amount ÷ state average monthly care cost = months of ineligibility. Transfers to spouses, disabled children, and certain caregiver children are exempt. California uses a 30-month lookback only.
Medicaid planning strategies
Elder-law attorneys use legitimate tools within the rules: irrevocable Medicaid trusts (5+ years before need), annuity conversions (turn countable assets into income stream), spousal refusal, caregiver agreements, and life estates on real property. Start planning 5+ years in advance when possible — crisis planning when already needing care has far fewer options.
Estate recovery
After death, states must attempt recovery of Medicaid benefits paid from the estate, typically via the home. Protection strategies: life estate deeds, lady bird deeds (in some states), transfer to exempt caregiver child.
Traditional vs hybrid LTC insurance — is it worth it?
Traditional LTC insurance
Pays a daily or monthly benefit when you can’t perform 2+ activities of daily living or have cognitive impairment. Typical policy: $200/day ($6,000/mo), 3-5 year benefit period, 90-day elimination, with 3-5% compound inflation protection. Premiums at age 55 in good health: $2,100/yr (single), $4,200/yr (couple). Double each decade. Premiums are not guaranteed — insurers have repeatedly raised rates.
Hybrid life/LTC policies
Permanent life insurance with an LTC acceleration rider. Benefits: guaranteed premiums, death benefit if LTC not used, simpler underwriting, no “use it or lose it” anxiety. Typical structure: $100k-$500k single premium or 10-pay, accelerates 2-4% of death benefit per month for LTC need. Most growing segment of the LTC market.
When LTC insurance makes sense
- Middle-wealth households ($300k-$2M net worth): Too wealthy to qualify for Medicaid quickly, not wealthy enough to easily self-fund 5 years of nursing home care
- Wealthy households ($2M+): Can self-insure. LTC still useful to preserve legacy for heirs.
- Lower-wealth ($300k or less): Will likely spend down to Medicaid anyway. Premium dollars better spent on other priorities.
Partnership programs
Most states have LTC Partnership programs that let you shield an additional amount of assets from Medicaid spend-down equal to the LTC benefits paid out. Check your state’s program — can be a big deal for middle-wealth households.
❓ Frequently askedFrequently asked questions
Does Medicare pay for long-term care?
Mostly no. Medicare covers up to 100 days of skilled nursing facility care after a qualifying 3-day hospital stay. It does NOT cover custodial care, assisted living, memory care, or long-term nursing home stays. Most long-term care is paid privately or via Medicaid.
How much does a nursing home cost in the US?
2024 national medians: $8,929/month semi-private room ($107,146/yr), $9,733/month private room ($116,796/yr). Alaska tops $30,000/mo; Louisiana and Texas come in below $6,000/mo. Memory care: $7,899/month. Assisted living: $5,350/month.
What is Medicaid spend-down?
Using your assets on care until you qualify for Medicaid’s asset limit — typically $2,000 for singles, $154,140 for the community spouse. Primary home (up to equity cap), one car, personal property, and prepaid burial are exempt. A 5-year lookback penalizes gifts made within 5 years of applying.
Can Medicaid take my house?
Not while you’re alive if a qualifying person lives there (spouse, minor child, disabled child, or caretaker child). After death, states must pursue estate recovery — often via the home. Life estate deeds, lady bird deeds (in some states), and transferring to a caretaker child can protect the home. Consult an elder-law attorney.
Should I buy long-term care insurance?
Best for middle-wealth households ($300k-$2M). Traditional LTC is cheaper at younger ages but premiums can rise. Hybrid life/LTC has guaranteed premiums and a death benefit. Under $300k wealth, you’ll likely spend down to Medicaid anyway. Over $2M, you can self-insure.
What is the average length of stay in a nursing home?
Median is ~13 months; mean ~2 years. 30% of residents stay over 3 years. Dementia patients typically stay 2-4 years. Plan for 3-5 years of private-pay reserves if you want to delay Medicaid spend-down.
What is a Medicaid 5-year lookback?
When you apply for Medicaid, the state reviews asset transfers in the 60 months prior. Gifts trigger a penalty period equal to transferred amount ÷ state average monthly nursing home cost. Transfers to spouses or disabled children are exempt. California uses a 30-month lookback only.