Almost 70% of people who reach 65 will need some form of long-term care before they die. Many people assume a spouse or an adult child will step in when the time comes. Often, that is exactly what happens.

What happens when a spouse or adult child cannot take on the care load? They may be willing but unable to provide care because of distance, time commitment, cost and the state of their own health.

One way to cover costs is with long-term care insurance. LTC insurance covers services like home care, assisted living, and help with daily tasks. Rates are typically lower if you buy in your 50s or early 60s, couples often qualify for discounts, and premiums may even be tax-deductible.

What is long-term care?

If an individual needs help with day-to-day living, it is considered long-term care. For example, bathing, dressing, eating, getting to the bathroom, moving from a bed to a chair. It is not medical treatment, so it falls outside the health coverage people assume they already have.

Medicare pays for short stretches of skilled care, up to 100 days in a skilled nursing facility per benefit period after a qualifying hospital stay, but it does not cover long-term custodial care when help with daily living is all you need. That bill generally falls to you, through savings or a long-term care policy.

Medicaid can cover long-term care for people who meet their state’s financial and functional eligibility rules, often after they’ve spent substantial assets.

For a policy to pay, a licensed health care practitioner has to certify that you cannot perform at least two of six daily activities without substantial help and expect that to last at least 90 days, or that severe cognitive impairment such as dementia leaves you needing constant supervision. The insurer, not you, decides when the benefit begins.

Long-term care can be expensive. CareScout’s 2025 cost-of-care survey put the national median for assisted living at $74,400 a year, and a private nursing home room at $129,575. Nearly 70% of people turning 65 will need some care, and 20% will need it for more than five years.

Who cares?

Most long-term care in America is provided by unpaid family members. About 59 million Americans care for an adult family member, friend or neighbor. AARP estimates the 49.5 billion hours of care they provided in 2024 would have cost more than $1 trillion at market rates. Three in five of those caregivers are women, typically aged around 51.

Caregivers of adults 50 and older now average 26 hours a week, up from 22 in 2020. Many keep it up for years, and nearly a third are raising children at the same time. Some cut their hours or leave a job to manage it, trading their own earnings and retirement savings for a parent’s care.

Most long-term care policies reimburse eligible expenses. Depending on the contract, reimbursable care may have to come from an eligible professional or agency, and payments for care provided by family members may be restricted or excluded. Check the contract’s definition of an eligible caregiver before you assume otherwise.

A smaller set of policies, called indemnity or cash benefit plans, work differently. Once you qualify, they pay a set amount regardless of your actual expenses, giving you more flexibility in how you use the money, including paying a family caregiver when the policy allows it. Fewer insurers sell these, and they tend to cost more.

Who will care for you?

Start with an honest conversation. Ask family members whether they could realistically care for you, what kind of care they are willing to provide and for how long.

Then take stock of your own risk. Your age, health, and family medical history may mean you are more or less likely to need long-term care in the future. Know what you are covering. Given that Medicare generally does not fund long-term custodial care, decide what you would lean on instead: savings, a policy, or other ways to cover the cost.

If you are considering long-term care insurance, remember that the younger you buy, the lower the premium. This means you pay for longer, but prices are usually locked in when you take out insurance. If you wait, premiums rise and a change in health can make coverage harder or impossible to get. People considering a long-term care policy often start looking in their 50s or early 60s.

A little planning now can spare your family a difficult financial situation later. See a list of the best LTC insurance companies. It takes two minutes.