Guide: How to Pay for Long-Term Care

Nobody wants to think about reaching a point where they don’t have total independence — much less the financial cost that comes with that. But planning for long-term care can help ensure that you’ll have the funds you need to get the right care that helps you continue to live the way you want to live.

The actual cost of long-term care varies depending on where you live and what type of care you require. The payment options also vary. Here’s a list of some of the most common ways people pay for long-term care:

• Medicare 

• Medicaid 

• Out-of-pocket 

• Insurance 

• Annuities 

If you or a loved one are seriously considering long-term care, figuring out a payment plan (and understanding median costs) will help you avoid headaches down the road.

Our parent company, Genworth, created a comprehensive, easy-to-use tool that calculates the costs of long-term care across the United States. Since 2004, they’ve tracked the cost of long-term care services nationwide; the annual results of these surveys are built into their Cost of Care Calculator to accurately project what costs look like today, as well as predict what they’ll look like in the future. Neat, right?

Before we dig into the cost of long-term care, there's an important distinction to make between two types of in-home care — home care and home health care.

Home care, also known as personal care, refers to non-medical care provided in the comfort of your home. Home care is split into two types: homemakers and home health aides. Homemaker services handle everyday tasks such as running errands, managing finances, and cooking. A home health aide is a professionally trained caregiver who helps with the activities of daily living (ADLs) like bathing, dressing, or toileting and instrumental activities of daily living (IADLs) like preparing meals and shopping for groceries.

On the other hand, home health care is for those needing assistance with medical needs such as injections, wound dressing, medication management, and health monitoring. 

Below, let’s look at the different long-term care options available, and learn how — with the help of our calculator tool — to price each of them out. 

Note: For each example below, we’ll assume the national monthly median cost (before insurance, Medicaid, or Medicare) predicted for 2024 based on an inflation rate of 5%. The costs for home maker and home health aide services are estimated at 44 hours per week; please remember that costs vary significantly based on where you live and how much care per week you need. For more area-specific results, you can type your ZIP code and desired year into the tool.  

National Monthly Median Cost, 2024: 
$6,006 

Homemaker or PCA services help you with shopping, finances, cooking, errands, and transportation. Homemaker services may also be employed to provide companionship.

This type of care usually requires private pay. If you have long-term care insurance your policy might cover these costs; however, long-term care policies vary widely, so make sure you review your policy to understand your eligibility, elimination periods, covered services, and daily maximums.  

National Monthly Median Cost, 2024:
$6,607 

A home health aide is a trained care professional who provides more extensive care and can provide hands-on assistance with activities of daily living (ADLs), like bathing, dressing, and instrumental activities of daily living (IADLs) like housekeeping, and transportation.

These services are typically covered by Medicare. For information on Medicare, you may visit medicare.gov. However, many qualifying factors need to be met before Medicare will cover the costs. Always speak with your individual Medicare plan provider to determine what coverage you may receive (and how long Medicare will pay for it).

Additionally, home health aide services may be covered through Medicaid, which provides health insurance coverage to low-income, blind, or disabled individuals. For information on Medicaid, you may visit medicaid.gov.

Since Medicaid is a state-run program, coverage varies by state. Many states offer what’s called “home and community-based waiver services.” This means that Medicaid pays for services such as home care, adult day health care, or assisted living communities (more on those below) as an alternative to being in a long-term care nursing home.

It’s important to note that not every in- home care, adult day health care, or assisted living community accepts Medicaid as a form of payment. You would additionally need to be eligible for the Medicaid waiver based on your income, assets, and functional ability.

National Monthly Median Cost, 2024:
$2,161 

Adult day health care centers provide supervised care and activities for adults who need companionship or support with mobility and daily functions. Adult day health care is often paid for privately, through long-term care insurance, or by Medicaid community-based waivers. Adult day health care is a more affordable option compared to home care or senior living communities. Depending on where you live, however, you might not have centers available near you. 

Adult day health care is sometimes covered through long-term care insurance. Review your policy with your insurance provider to determine eligibility, elimination periods, covered services, and daily maximums. You might also be able to use Medicaid to pay for adult day care services. First, you would need to determine if you are eligible for the Medicaid home and community-based waiver; then your state would need to consider adult day health care a covered service. Additional costs, including transportation to and from the center, supplies, etc., may not be covered by the waiver. 

National Monthly Median Cost, 2024: 
$5,618 

Assisted living communities are residential centers that provide some nursing and personal care services. Some assisted living communities may only accept private pay or long-term care insurance. As with other forms of care, your long-term care policy may or may not cover assisted living. Check with your insurance provider to determine your coverage. 

Some assisted living communities participate in Medicaid’s home and community-based waiver programs. These waiver programs may cover individuals who are assessed to be “nursing home eligible.” However, most assisted living communities do not participate in the waiver program, and some waiver programs only cover personal care provided in the facility, not room and board. Each state varies considerably in what is considered a Medicaid covered service, so always meet with a Medicaid specialist if you’re interested in learning more. 

National Monthly Median Cost for a Semi-Private Room, 2024: 
$9,102 

National Monthly Median Cost for a Private Room, 2024: 
$10,220 

Short term rehabilitative stays in a nursing home may be paid for by Medicare if the preceding hospitalization is deemed qualified by them. Medicare generally covers 100 days of skilled nursing facility care per benefit period. Typically, the first 20 days are covered 100% by Medicare, with the remaining 80 days requiring a co-payment. Always speak with your individual Medicare plan provider with specific questions regarding coverage. 

If you’re in a nursing home for long-term care, you can either privately pay or use long-term care insurance. If you have a long-term care insurance policy, check with your insurance carrier to understand your coverage. If you are eligible, Medicaid may cover your long-term care expenses in a nursing home that accepts Medicaid payment.

As you research different care options, you’ll discover that rates often vary depending on your payment method. If you’re paying privately, you’ll receive the “private pay rate.” If you’re switching to another payor source such as Medicare, the care provider will charge Medicare a negotiated Medicare rate. Likewise, Medicaid has specific rates that they charge for services.  

Nursing homes assess rates differently. If you’re admitted to a nursing home that accepts Medicaid, you’ll be required to pay the private pay rate until you spend down your assets sufficiently to be Medicaid eligible. Once you have sufficiently spent down your assets, you’ll complete an application for Medicaid. If approved, the rate you pay to the facility is based on your individual income, leaving a small portion for a personal needs account, typically housed within the facility.  

For example: let’s say you’re approved for Medicaid long-term care and your income is $800 per month; $730 may go towards the facility costs and $70 per month might be held for you to use on takeout food, new clothing, haircuts, social outings, etc. (Please note: these numbers are just hypothetical examples.) 

As you can see, there are many factors that can impact the cost of long-term care. Your individual resources, long-term care insurance policy, and Medicare and Medicaid resources are all considered when paying for care. Before you sign any dotted lines, make sure you speak with whoever manages your money or accounts such as an insurance agent or financial advisor. You want to have all the facts before making such an important decision.