Who Pays for Long-Term Care

In 2019, an estimated $426.1 billion was spent on LTSS, representing 13.3% of the $3.2 trillion spent
on personal health care.

In 2019, private sources accounted for 30.5% of LTSS expenditures. Within the category of funding, out-of-pocket spending was the largest component (over one-half of private sources), comprising 14.9% of total LTSS expenditures. Second was private insurance (9.0%), which includes both health and long-term care insurance. Other private funding, which largely includes philanthropic contributions, comprised 6.6% of total LTSS. The following provides a brief discussion of the various public and private sources of LTSS funding. (Congressional Research Services)

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• Median annual private pay costs for home health services average 88% of an older person’s annual income, nationally. This ranges from 55% to 125% across states.

• One in four people age 45 and over are not at all prepared financially if they suddenly required long-term care for an indefinite period of time.

• Approximately 56% of individuals age 65 and older (as compared to adults 45-64) and more than half of adults with incomes over $25,000 annually were more likely to say they feel financially prepared for long-term care than their counterparts.

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Public sources paid for the majority of LTSS spending (69.5%). Medicaid and Medicare are, respectively, the first and second-largest public payers, and in 2019 accounted for nearly two-thirds (63.4%) of all LTSS spending nationwide. (Congressional Research Services)

$30 billion: Long-term care expenditures in the U.S., 2000.


$225 billion: Long-term care expenditures in the U.S., 2015.


57.5%: Percentage of individuals turning 65 between 2015 and 2019 who will spend less than $25,000 on long-term care during their lifetimes.


15.2%: Percentage of individuals turning 65 between 2015 and 2019 who will spend more than $250,000 on long-term care during their lifetimes.


$341,840: Estimated lifetime cost of care for someone with dementia.

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That growth will increase total spending on SNFs and CCRCs to $196 billion in 2018, and $274 billion by 2024, according to the NHE report. By comparison, Medicare beneficiaries spent $160 billion on both SNF and CCRC facilities in 2017. For year 2018, the figure is set to be $167 billion.

Medicaid is the largest single payer of LTSS in the United States; in 2019, total Medicaid LTSS spending (combined federal and state) was $182.8 billion, which comprised 42.9% of all LTSS expenditures.
(Congressional Research Services)

In 2019, Medicaid LTSS accounted for 33.3% of all Medicaid spending, which represented about 5.5% (4.7 million) of the enrolled population who received Medicaid-covered LTSS in FY2018
(Congressional Research Services)
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$18,200: Median annual cost for adult day care (five days/week), 2017.


$45,000: Median annual cost for assisted-living facility, 2017.


$85,775: Median annual nursing-home cost, semiprivate room, 2017.


$97,455: Median annual nursing-home cost, private room, 2017.


$215,770: Average annual nursing-home cost, private room, Manhattan, 2017.


$51,100: Average annual nursing-home cost, private room, Monroe, Louisiana, 2017.


$23,394: Median annual income from all sources for individuals who are 65 or older.

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$23,394: Median annual income from all sources for individuals who are 65 or older.


$39,823: Median annual income for households headed by people 65 or older.


3.8%: Five-year annual inflation rate in nursing-home costs, private room, 2017.


5.5%: One-year annual inflation rate in nursing home costs, private room, 2017.


19%: Percentage of long-term care costs that were paid out of pocket, 2013.


8%: Percentage of long-term care costs that were paid by private insurance, 2013.


$263,200: Median household wealth for adults age 65 or older with no disabilities.


$94,200: Median household wealth for adults age 65 or older with limitations on two or more activities of daily living.