By Christian BrinkleyLicensed NC Insurance Agent, NPN 22217190, NC Life & Health · Updated November 7, 2026 · 4 min read
It is the question behind every long-term care conversation: will I need care, and can I pay for it without a policy? Care is likely, and the answer is personal. Here are the numbers that decide it, the ages that matter, and the cases where a policy helps and where it does not.
The odds, with context
The U.S. Department of Health and Human Services studied adults who reach 65 and found that about 70% develop severe long-term care needs before they die, and 48% receive some paid care. Women need care longer on average, about 3.7 years, compared with about 2.2 years for men. About one in five people who need care need it for more than five years.
Those figures cover a wide range, from a few weeks of help at home after a hospital stay to years in a nursing home. Averages cannot tell you which you will be. They can tell you that planning as if no care will be needed leaves the largest gap.
What Medicare does not pay for
Medicare does not pay for ongoing help with everyday activities, such as bathing, dressing, or eating, when that is the only care needed. It covers skilled nursing facility care up to 100 days per benefit period, with no coinsurance for days 1 to 20 and $217 a day for days 21 to 100 in 2026. It covers skilled home health care in limited circumstances, not round-the-clock help at home.
That leaves three ways to pay for the rest: savings, a policy, or Medicaid if you qualify. Medicaid has strict income and asset rules, and it is not a plan for protecting savings. Check eligibility with NC Medicaid rather than assuming.
Who needs a policy, and who can self-fund
Start with the cost of care. In 2025, the national median for a private nursing home room was $129,575 a year, assisted living was $74,400 a year, and a home caregiver at 44 hours a week was about $80,080 a year. CareScout calculated that $250,000 covers about 2.8 years of care on average nationally. If your savings could absorb several years at those rates and still leave your spouse comfortable, you may be able to self-fund.
A policy usually fits when care would drain savings your spouse still needs, when you want to choose where care happens, or when family would otherwise carry the load. It usually does not fit when premiums would strain the budget, or when income and assets are low enough that Medicaid is the realistic payer. There is no single right answer, only the math for your household.
What age to buy
The AALTCI 2025 Price Index prices a standard policy with a $165,000 benefit pool growing 3% a year. A healthy man paid on average $2,200 a year at 55, $2,610 at 60, and $3,280 at 65. A healthy woman paid $3,750 at 55, $4,550 at 60, and $5,290 at 65. A couple both the same age paid $5,050 at 55, $5,800 at 60, and $7,150 at 65 combined.
AALTCI recommends shopping between ages 52 and 64, when approval is most likely and rates are still moderate. Buying at 55 instead of 65 saves a healthy man $1,080 a year on the same coverage, and it locks in coverage before health changes can narrow the options. After 70, underwriting tightens and some people can no longer qualify.
What to check before you buy
Check the benefit pool, the daily or monthly benefit, and how long benefits last. Check the elimination period, the waiting time before benefits start, and what triggers benefits, usually needing help with two everyday activities or a cognitive impairment. Check whether benefits grow with inflation, whether premiums can rise, and what happens if you stop paying.
- Ask for the full premium history of the policy, not just the first year.
- Compare the same benefit pool and inflation growth across insurers.
- Bring any policy you already own to the review before replacing it.
Questions people ask me about this
Does Medicare cover long-term care?
No, not ongoing custodial care. Medicare covers skilled nursing up to 100 days per benefit period and limited skilled home health care. Daily help with bathing, dressing, and eating is not covered.
What age should I buy long-term care insurance?
Most buyers shop between 52 and 64, when approval is most likely and premiums are still moderate. A healthy 55-year-old man paid about $2,200 a year in the 2025 AALTCI index, against $3,280 at 65 for the same coverage.
What if I buy a policy and never need care?
A standalone policy pays nothing back if care is never needed. That is the tradeoff. A hybrid policy pairs life insurance with care benefits, so beneficiaries receive a death benefit if care is never used, but it costs more per year.
Can premiums go up after I buy?
Yes, on a traditional policy, premiums can rise if the insurer raises rates for a group of policyholders. Ask for the policy's premium history and what choices you would have if premiums became hard to afford.