Almost 70%. That is the chance, according to the federal government's long-term care site, that someone turning 65 today will need some type of long-term care. This week, as people sit down to compare Medicare plans for 2027, that number is worth holding next to the plan cards, because the cost it points to is not on any of them.
Does Medicare pay for long-term care?
No. Medicare's own page on long-term care says it plainly: "Medicare doesn't pay for long-term care," and for those services, "You pay all costs." It also says Medicare Supplement Insurance, the Medigap policies many of our clients carry, does not pay for long-term care either, whether the care happens at home, in the community, or in a nursing home.
Long-term care here means help with everyday living for someone with a chronic illness or disability: bathing, dressing, eating, getting in and out of bed. It is the kind of help a person may need for months or years, and it is different from the medical care Medicare was built to cover.
What about the nursing home coverage people hear about?
That is skilled nursing care, and it is a short, specific benefit. Medicare covers a stay in a skilled nursing facility after a medically necessary inpatient hospital stay of at least three days in a row, generally when you go in within 30 days of leaving the hospital and need daily skilled care, like therapy after a surgery. For 2026, after the $1,736 Part A deductible, days 1 through 20 cost $0. Days 21 through 100 cost $217 a day. After day 100, you pay all costs.
In other words, it is built for recovery, not for the years of help with daily living that long-term care usually means. A plan card that mentions skilled nursing is not telling you that long-term care is covered.
What does long-term care cost today?
More than most people guess. CareScout's 2025 Cost of Care Survey, an industry survey rather than a government figure, puts the national median at:
- Nursing home, private room: $129,575 a year
- Nursing home, semi-private room: $114,975 a year
- Assisted living: $6,200 a month, or $74,400 a year
- Care at home: $35 an hour, about $80,080 a year at 44 hours a week
Those are national medians, and costs in your area may be higher or lower. How long care lasts matters just as much as the price. The federal long-term care site says women who need care need it longer than men, 3.7 years compared with 2.2, and 20% of people will need it for longer than five years.
How can a couple pay for long-term care?
Medicare.gov points to Medicaid and private long-term care insurance, besides paying the costs yourself. In practice, the answer is often a mix of these:
- Savings and income. Paying as you go from your own assets. It keeps the most control, and it puts the most of your money at risk.
- Medicaid. It does pay for long-term care, but only for people who meet their state's eligibility rules, which include strict limits on income and assets.
- Private long-term care insurance. A policy you buy ahead of time that pays toward care once you qualify.
- Hybrid coverage. Some life insurance policies and annuities include long-term care benefits, so the money does a job whether or not care is ever needed.
For couples, the real question is usually not "who pays for care" but "what happens to the other spouse." If one of you needs years of care, the income and savings the healthy spouse will live on are the ones most at risk. That is why long-term care belongs in the same conversation as your retirement income plan and your inheritance plan, not in a separate drawer.
When does a long-term care policy start paying?
When a benefit trigger happens, and then usually after a waiting period. According to the federal long-term care site's guide to receiving benefits, most policies pay when you need help with two or more of six activities of daily living or when you have a cognitive impairment. Those are the two triggers worth finding in any policy you own or consider.
Then there is the elimination period, the time that has to pass after a trigger before the policy starts paying. It is chosen when you buy the policy, often 30, 60, or 90 days, and you cover the cost of care during it.
What questions should a couple settle now?
None of this requires a decision this week. It does reward a calm conversation before anyone needs care. A few questions to start with:
- If one of us needed help at home, who would provide it, and for how long could they?
- Which savings would pay for care, and what would that do to the other spouse's income?
- If we already own a policy, what are its triggers, how long is the elimination period, and does the benefit grow over time?
- Where does Medicaid's eligibility line sit in our state, and how far are we from it?
Where does this fit with plan shopping?
The Annual Enrollment Period runs October 15 to December 7, and it is the right time to choose the plan that fits your doctors, hospitals, and prescriptions for 2027. Just know what that choice covers and what it does not. Long-term care is a planning question, not a plan-card question.
It is also one of the single-page guides Eddie and Betty keep in our new library, under a simple promise: a plan for care, before you need it. If you would like to walk through it with one of our advisors, American Retirement Advisors is at 602-281-3898.
Disclaimer: This article is for educational purposes only. It is not sponsored, endorsed, or otherwise representative of Medicare or the federal Medicare program. American Retirement Advisors is not a government agency. For official Medicare information, visit medicare.gov or call 1-800-MEDICARE (1-800-633-4227).