Short answer: at 2025 prices a year in a private nursing home room costs a median $129,575 in the U.S., and a full-time home caregiver $80,080 (CareScout Cost of Care Survey 2025). The average person turning 65 who needs care uses about 3 years of it (ACL, LongTermCare.gov). Pick your state and metro below to see your own number, the year it lands, and what each way to pay would take.
3% is CareScout's own default. Averages: ACL, LongTermCare.gov.
Get your full number and the four ways to pay for it
One page by email: your care bill year by year, what it costs in today's dollars, and what each way to pay would take.
Four ways families pay for care, run on your plan. None is right for everyone; the right one depends on your health, your savings and who else depends on that money.
No premiums and no health questions, and if you never need care the money stays yours. The risk is the long stay: 1 in 5 people need care for more than 5 years, and the bill comes out of the same money a spouse lives on. Pulling it from an IRA or annuity gains adds taxable income, though care costs can count as medical expenses above 7.5% of income (IRC 213).
Usually the most care per premium dollar. Benefits from a tax-qualified policy are generally not taxable income. The trade-offs: premiums are usually not locked, so the insurer can raise them for a whole group of policyholders with state approval; if you never need care, nothing comes back; and you have to qualify on health. For 2026, part of the premium can count as a medical expense, up to $4,960 a person at ages 61 to 70 and $6,200 over 70 (Rev. Proc. 2025-32).
You pay one premium or a set number of them. If you need care, benefits come out of a long-term care pool; if you never do, your heirs get a death benefit. It takes more money up front than traditional coverage and you still have to qualify on health. Tax: an existing life policy can be exchanged into one without tax (IRC 1035(a)(1)), and rider charges taken from the policy's cash value are not taxable income (IRC 72(e)(11)). An annuity cannot be exchanged into life insurance.
Money you already have in the bank or an old annuity goes into a contract that pays a multiple of its value if you need care, and stays yours (or your heirs') if you do not. Since 2010 (Pension Protection Act of 2006), an old annuity with a big gain can be exchanged into one without tax (IRC 1035(a)(3)), and charges for a qualified long-term care rider are not taxable income (IRC 72(e)(11)), so old gains can end up paying for care. Multiples, waiting periods, caps and health questions differ by contract, and some confinement or income doubler features are not qualified long-term care, so the tax treatment differs. The 2x and 3x here are illustrations, not quotes.
Assets needed today = each month of care discounted back to 2026 at your return. Pools ignore benefit caps, waiting periods and premiums. Medicare does not pay for ongoing custodial care; Medicaid can, once you meet your state's income and asset rules.
It takes the median price of each kind of care where you live, lines the care up in the order most people use it (home first, a facility later), and raises each year's price by the care inflation you choose until the year it happens. If you plan for two people, each person's care starts when they reach the age you set, so the bills can land years apart.
| Care setting | National median, per year | How CareScout prices it |
|---|---|---|
| Home care (non-medical caregiver) | $80,080 | $35 an hour, 44 hours a week, 52 weeks |
| Adult day health care | $24,700 | Daily rate, 5 days a week, 52 weeks |
| Assisted living | $74,400 | Monthly private-pay rate x 12 |
| Nursing home, semi-private room | $114,975 | Daily rate x 365 |
| Nursing home, private room | $129,575 | Daily rate x 365 |
Source: CareScout Cost of Care Survey 2025, Median Cost Data Tables (document 282102, dated March 2, 2026), survey conducted July to November 2025 with about 16,000 provider responses across 434 regions. CareScout is a Genworth company; this is the survey long known as the Genworth Cost of Care Survey. In 2025 CareScout stopped reporting homemaker and home health aide separately and combined them as non-medical caregiver, so this calculator has one home care line.
From ACL's LongTermCare.gov (HHS; page last updated February 18, 2020): someone turning 65 has almost a 70% chance of needing some long-term care. Women need it longer (3.7 years on average) than men (2.2 years). One-third never need it; 20% need it for more than 5 years. On average, about 2 years are spent getting care at home and 1 year in a facility, which is why the calculator starts with that plan.
Medicare does not pay for ongoing custodial care, at home or in a nursing home (Medicare.gov, read October 14, 2026). It helps with short skilled nursing stays after a hospital stay. Medicaid pays for long-term care only after you meet your state's income and asset limits, which for most homeowners with savings means spending down first. Everything else comes from savings, family, or insurance you set up before you need it.
The total is the scary part; the funding choice is the part you control. A couple with $1,000,000 saved can usually self-fund one long stay, but two stays back to back can leave the survivor with far less to live on. Insurance moves that risk to an insurer for a price. The newer designs, hybrid life policies and annuities with long-term care benefits, appeal to people who hate the idea of paying premiums for something they may never use: the money is still there for heirs if care is never needed.
The tax rules are the quiet advantage. Since 2010, the Pension Protection Act of 2006 (section 844) lets an annuity be exchanged tax-free under IRC 1035 into an annuity with a qualified long-term care rider, or into a qualified long-term care policy, and IRC 72(e)(11) treats the rider charges as not taxable. For someone sitting on an old annuity with a large untaxed gain, that can mean the gain pays for care instead of the IRS. It only works with a qualified long-term care contract, and only as a direct exchange; cashing out first makes the gain taxable.
Medians are the middle price, not the price at the facility you would choose. It does not model Medicaid eligibility, the VA, family caregiving, the cost of moving, one-time assisted living entrance fees, home changes, or premiums for any policy. The insurance figures are the size of benefit or pool the plan would use, not a quote, and real policies have caps, waiting periods and health rules. Use it to size the problem; a real plan needs your health, your savings and current offers.
Q: What care prices does this long-term care cost calculator use?
A: National medians from the CareScout Cost of Care Survey 2025 (survey July to November 2025, tables dated March 2, 2026): $80,080 a year for a non-medical home caregiver 44 hours a week, $24,700 for adult day care 5 days a week, $74,400 for assisted living, $114,975 for a semi-private nursing home room and $129,575 for a private room. Your state and metro can be far above or below that.
Q: Does Medicare pay for long-term care?
A: No, not for ongoing custodial care. Medicare.gov says Medicare and most health insurance, including Medigap, do not pay for long-term care services, in a nursing home or at home. Medicare covers short skilled nursing stays after a qualifying hospital stay. Medicaid can pay once you meet your state's income and asset rules.
Q: How long does long-term care last?
A: About 3 years on average for people turning 65, per the federal LongTermCare.gov data from ACL (HHS): women about 3.7 years, men about 2.2. Roughly 70% of people turning 65 will need some care, one-third never will, and 20% will need it for more than 5 years. On average about 2 of those years are at home and 1 in a facility.
Q: Can I use an old annuity to pay for long-term care without paying tax on the gain?
A: Possibly. Since 2010 (Pension Protection Act of 2006, section 844), IRC 1035 lets you exchange an annuity for another annuity or for a qualified long-term care contract without tax, and IRC 72(e)(11) says charges taken from an annuity's cash value to pay for a qualified long-term care rider are not taxable income (they reduce your basis). Whether the benefits come out tax-free depends on the rider being a qualified long-term care contract; some confinement or income doubler features are not.
Q: Can I 1035 an annuity into a hybrid life and long-term care policy?
A: No. IRC 1035(a)(3) allows an annuity to go into another annuity or a qualified long-term care contract, not into life insurance. A life insurance policy can be exchanged into another life policy (including a hybrid with a long-term care rider), an annuity or a qualified long-term care contract (IRC 1035(a)(1)).
Q: What inflation rate should I use for care costs?
A: CareScout's own cost of care tool uses 3% a year as its default, so this calculator does too. From 2024 to 2025 its national medians rose about 1% to 5% depending on the setting (for example assisted living went from $5,900 to $6,200 a month). Try 4% or 5% to see a higher-cost path.
This calculator is for education only. It is not a quote, a recommendation of any product, or tax or legal advice for your situation. Care cost figures are CareScout Cost of Care Survey 2025 medians; actual prices vary by provider and change every year. Insurance and annuity products are offered through Goldstein & Co. LLC dba Goldstein Insurance Services, CA License #6016830; Hans Goldstein, CA Insurance License #4273294, NPN 20602398. Guarantees are backed by the issuing insurer's claims-paying ability. Long-term care benefits depend on the contract's terms, health underwriting and benefit triggers. Talk with your CPA or attorney before you act on the tax points above.
Hans Goldstein is an Enrolled Agent, admitted to practice before the Internal Revenue Service. Not affiliated with or endorsed by the IRS. General education, not tax or legal advice for your situation.