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What long-term care costs,
actually, in 2026.

The numbers that drive every Medicaid penalty divisor, every family's private-pay runway, and every spend-down decision. Nursing home, assisted living, and home care — state by state.

By The ElderCareAtlas Editors··Last reviewed

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What does long-term care cost in 2026?

A semi-private nursing-home room costs approximately $9,800/month ($117,600/year) at the US median in 2026. Range: $6,200 in low-cost states to $15,600 in Alaska. Assisted living is $4,500-$7,800/month. Home health aides are $32-$45/hour. These figures drive each state's Medicaid penalty divisor.

Why these numbers matter beyond the sticker

The cost of care in your state drives three downstream numbers that matter for planning. First, the state's Medicaid penalty divisor — how fast existing gifts unwind against ineligibility months. Second, the private-pay runway — how long a given asset base lasts before Medicaid becomes necessary. Third, the breakeven point between home care and facility care for a specific care-need level.

Private-pay runway math

A household with $300,000 in non-home assets facing a $10,000/month nursing-home bill burns through that base in 30 months. Same household, same assets, facing a $13,500/month Massachusetts bill = 22 months. Same household facing a $7,400/month Oklahoma bill = 40 months. The geography of long-term-care cost is the geography of Medicaid planning urgency1.

Home care vs facility care

The breakeven is usually around 40-50 home-care hours per week for an applicant needing standard assistance. Below that, home care is cheaper; above that, nursing-home care (or memory care for dementia) gets competitive and then cheaper as hour requirements climb. But the non-financial calculus — family proximity, applicant preference, home safety, caregiver burnout — matters at least as much.

Next

The 2026 national median for a semi-private room is approximately $9,800/month ($117,600/year). Private rooms run 10-25% higher. Low-cost states (Louisiana, Missouri, Oklahoma) are in the $6,200-$7,400/month range; high-cost states (Alaska, Connecticut, Massachusetts, New York) exceed $13,000/month.
Assisted-living base rates run $4,500-$7,800/month in 2026 depending on state and facility tier. Memory-care add-ons add $1,500-$3,500/month. Unlike skilled nursing, Medicaid rarely pays assisted-living base rent — state waivers occasionally cover specific services within the facility.
Home health aides run approximately $32-$45/hour in 2026. A 40-hour/week in-home care schedule runs $5,500-$7,800/month — frequently less than a nursing home, but only if the applicant's care needs fit what a home aide can provide. Around-the-clock home care typically exceeds nursing-home cost.
Essentially no. Medicare covers up to 100 days of rehabilitation after a qualifying hospital stay (with most of that at reduced benefit). It does not cover long-term custodial care at any level — nursing home, assisted living, or home care. That's why Medicaid is the primary US payer of long-term care at roughly 60% of all dollars spent nationally.
The state's penalty divisor is derived from the state's private-pay nursing-home cost — the theory being that a gift roughly equal to one month's nursing-home cost "would have paid for" one month of care, so the recipient absorbs one month of Medicaid ineligibility. This is why high-cost states have high divisors and vice versa.

Sources

  1. Cost of Care Survey — Genworth Financial · nursing-home, assisted-living, and home-care rates by state, 2026
Next step

Compare your state's care cost against your runway.

The cost calculator takes the applicant's non-exempt assets and the state's monthly care cost and returns the private-pay runway — the crucial number that determines whether Medicaid planning is urgent or still elective.

Run the cost calculator →See all 50 states