How do you plan for long-term care?

Long-term care is the risk families most often leave undiscussed. Partly because it's uncomfortable. Partly because the products have historically been sold badly enough that avoiding the subject feels like the safer response.

But the cost doesn't disappear because nobody raised it. It lands on the survivor, during the period when they're least able to reorganise a plan.

The short answer. Answer one question: if one of you needed several years of significant care, what would fund it, and what would that do to the other? For households with substantial assets, self funding is often the right answer. It just needs to be a decision, with a number attached, rather than an omission.

What it actually costs.

CareScout surveys roughly 16,000 providers across all fifty states each year. These are the 2025 national medians.

Two things worth noticing. A median is a midpoint, and coastal California runs well above it. And in-home care looks like the cheapest line until the hours climb: at around the clock coverage it costs more than a private room.

Two things matter more than the headline figure.

Duration varies enormously. Many people need care for months. Some need it for years. The plan has to survive the long version, not the average one.

Location changes everything. Costs in coastal California look nothing like costs in the Midwest. If you might relocate to be near family, price the place you'd actually be.

What Medicare does not cover.

This is the most common and most expensive misunderstanding.

Medicare covers skilled nursing for a limited period after a qualifying hospital stay. It does not cover custodial care, which is the help with daily living that most long-term care actually consists of. Medicare states its own limits plainly, and it is worth reading before assuming otherwise.

Medicaid does cover it, after you've spent down assets to qualify. For households reading this, that isn't a plan. It's the outcome of not having one.

So the honest position is that this cost is yours, and the only question is whether you fund it from assets or transfer part of it to an insurer.

When self funding works.

For many of our clients it does, and we'll say so rather than steering toward a product we don't sell.

Self funding is a legitimate plan when three things are true.

• The portfolio can absorb several years of care for one person without compromising the survivor's own plan.
• Both of you understand the arithmetic, not just the person who handles the finances.
• The assets are reasonably liquid, or there's a plan for making them so.

That third one gets missed. An estate heavy in real estate or a closely held business can be wealthy and still short of cash in the year it's needed. See when does it make sense to borrow instead of sell.

When transferring some of the risk makes sense.

Insurance earns its place when self funding would work for one person but not two, when the assets are illiquid, or when you'd simply rather cap the exposure and stop thinking about it.

The market has changed in a way worth knowing about. Traditional standalone policies had a real objection: pay premiums for decades, need no care, and the money is gone. Hybrid policies address that by paying a death benefit if care is never needed.

They're more expensive for the same care benefit. Whether that trade is worth it depends on how much the "wasted premium" objection actually bothers you, which is a preference rather than a calculation.

What we'd avoid: buying the largest policy someone will sell you. Covering part of the cost, with assets covering the rest, is usually the better structure.

The conversation to have first.

Before any product discussion, three things need deciding, and they aren't financial.

Where would care happen? At home, near a particular child, in a community you've already looked at? The answer changes the cost materially.

Who would coordinate it? Not pay for it. Coordinate it. That's a significant job and it usually falls to one adult child by default rather than by agreement.

What would you want if you couldn't say? This belongs with your advance health care directive, which sits inside your estate plan.

Families who have this conversation early describe it as awkward. Families who have it during a crisis describe it as much worse than awkward.

Nothing here sits on its own.

A care event touches everything at once. It changes the spending plan, forces withdrawals in a year you may not have chosen, alters the tax picture, and can reshape what passes to your children.

It also changes the survivor's plan permanently, which is why we run that scenario separately rather than assuming it's a smaller version of the joint one. See what should a financial plan actually include.

Where to start.

1. Price care in the place you'd most likely be, at today's rates.
2. Run three years of it for one person against your portfolio, and look at what's left for the other.
3. If that result is uncomfortable, get quotes. If it's fine, write down that self funding is the plan, so nobody has to guess later.
4. Have the where and who conversation with your family while it's still theoretical.

We don't sell insurance and receive no commission on any policy, so we have no interest in which way this goes. What we care about is that it's answered rather than avoided.

If it hasn't been, let's talk.

Cosmos Wealth doesn't provide tax, legal, or medical advice. Cost figures here are CareScout's 2025 national medians, vary widely by market, and are revised annually. Coverage terms, eligibility, and Medicare and Medicaid rules are set by statute and change. Confirm current specifics before acting.