An Introduction To Planning For Long-Term Care

Long-term care is the kind of care you need if you are not able to perform normal daily activities (such as eating, dressing, bathing and toileting) without help, and it is expected that you will need this help for an extended period of time, often for the rest of your life.

This kind of care is often needed due to aging, chronic illness or injury, and most of us will need it for at least some time before we die. But it is not just for the elderly; a good number of younger, working-age adults are currently receiving long-term care due to accident, illness or injury.

Long-term care can be provided in your home, in an assisted living facility or in a nursing home. All can become very expensive. For practical legal advice about paying for long-term health care, contact Sjoberg & Tebelius, P.A. at 651-315-8856. We can explain your options and help you plan.

In 2025, the median national cost of assisted living was around $68,000 per year, and the more services you need, the higher the cost. In contrast, in-home health care was approximately $30/hour and over $21,000 per month (more than $250,000 per year) for round-the-clock care, and a semi-private nursing home room now averages over $111,000 per year (with average stays, not including those for Alzheimer patients, lasting approximately 485 days). Rising medical costs practically ensure that these costs will go even higher.

Unfortunately, long-term care is not covered by health insurance, disability income insurance, or Medicare. Health insurance plans cover nursing home expenses only for a short period of time, for example, while you are recovering from an illness or injury.

Disability income insurance will replace part of your income if you are not able to work after a specified time, but it does not pay for long-term care.

Medicare, which covers most people over the age of 65, provides limited coverage for skilled care for up to 100 days immediately following hospitalization. After that, you’re on your own.

So who will pay the cost if you need long-term care? There are only three sources: your own assets, Medicaid, and long-term care insurance.

Medicaid pays the bills for a large number of people in nursing homes today. But because the program is designed to provide services for those who cannot support themselves (e.g., children, the disabled, and the poor), you may have to “spend down” your assets before you qualify for benefits. Your spouse is also limited to the number of assets they can own. Also, you will only be able to receive care from a facility that accepts Medicaid.

For these reasons, long-term care (LTC) insurance is the best option for many people, especially those who have assets and income they want to protect, those who want to avoid being a financial burden on others, and those who want to have some choice in the care they receive. With LTC insurance, you will have the option of receiving care in your home or a private pay facility. The premiums are lower when you are younger and in good health. If you wait too long, the cost could be prohibitive and you might not qualify.

When planning for long-term care, the experience and advice of a qualified professional can be most helpful. If you are considering trying to qualify for Medicaid, make sure you talk with an expert in elder law before you do anything. An innocent mistake could disqualify you from receiving benefits for many months.