39% of Middle-Class Americans Expect Medicare to Pay for Long-Term Care — It Usually Won't

American families are dealing with the consequences of aging, and long-term care numbers we have never seen before because of greater longevity. Unfortunately, it often comes with aging and chronic health issues. Medicare plays a major role in paying health care expenses after age 65. But there's one major expense it generally doesn't cover: ongoing long-term care.

Many Americans apparently don't realize that. A new survey from the American Council of Life Insurers (ACLI) found that 39 percent of middle-class households expect Medicare to help pay for long-term care. Another 23 percent haven't thought about how they would pay for extended care at all.

Yet only 7 percent expect Long-Term Care Insurance to help pay the bill, since many people don't know it exists or think they do not need LTC Insurance. That's a significant planning gap, experts tell LTC News, since federal research estimates that 56 percent of people turning 65 will eventually need long-term services in their lifetime.

Medicare Misconception

The September 2026 ACLI Financial Resilience Survey, conducted by YouGov, surveyed 3,582 adults, including 1,404 people from middle-class households. ACLI defined middle-class households as those with annual household incomes between $50,000 and $150,000.

Long-term care isn't necessarily nursing home care, as most extended care is at home or in assisted living. Long-Term Care Insurance policies pay for all levels and types of extended care, whether at home, through adult day care, or in assisted living, memory care, or a nursing home.

You or a loved one may need this care because of aging, chronic illness, mobility problems, dementia, or other cognitive decline. The need can develop gradually or appear suddenly following an illness, accident, or other health event.

In many cases, family members provide at least some help because too many people fail to plan. Medicaid, however, will provide long-term care benefits for those with limited financial resources. Otherwise, American families must cover costs through their income and assets, family, or Long-Term Care Insurance.

Share your thoughts and experiences about aging, caregiving, health, retirement, and long-term care with LTC News —Contact LTC News.

56% Will Need Long-Term Care

The risk of needing long-term care is high and increases with age. Federal research estimates that if you reach age 65, you will have a 56 percent chance of developing a need for long-term services in your lifetime. The estimate uses the federal definition of long-term care as needing help with at least two activities of daily living or supervision because of serious cognitive impairment.

That standard is the same benefit triggers used by tax-qualified Long-Term Care Insurance. Tax-qualified Long-Term Care Insurance uses two benefit triggers: needing substantial assistance with at least two of six activities of daily living for an expected period of at least 90 days, or requiring substantial supervision because of severe cognitive impairment.

The six activities of daily living are:

• Bathing
• Continence
• Dressing
• Eating
• Toileting
• Transferring

The consequences of needing care often extend beyond the person receiving it, as 63 million Americans are family caregivers. Six in 10 family caregivers are also employed. That means a long-term care need can affect much more than retirement savings. Family members who also serve as caregivers may have to change work schedules, reduce hours, or take time away from their careers to provide care.

Families often believe Medicare or some government program will cover longterm care, and that misunderstanding leads straight to crisis. People with LongTerm Care Insurance understand the reality, as millions in benefits are paid daily.” — Matt McCann, CLTC, long-term care planning expert.

What Medicare Actually Covers

Medicare doesn't pay for ongoing long-term care when someone needs help with everyday activities or supervision because of cognitive impairment. Original Medicare Part A may cover short-term care in a skilled nursing facility when Medicare's requirements are met. Under traditional Medicare rules, that generally includes a qualifying three-day inpatient hospital stay before admission to the skilled nursing facility.

There are exceptions. Some Medicare Advantage plans and certain Medicare arrangements may waive the three-day requirement. For covered skilled nursing facility care in 2026, after any applicable Part A deductible, beneficiaries generally pay:

• $0 per day for days 1 through 20.
• $217 per day for days 21 through 100.
• All costs beginning on day 101.

The Part A deductible is $1,736 in 2026. A beneficiary doesn't pay it again for skilled nursing facility care if it was already paid for hospital care during the same benefit period. The deductibles change every year, so check the Medicare website for details.

Medicare may also pay for qualifying skilled home health services. The key difference is the type of care being provided. Medicare may pay for short-term skilled nursing, rehabilitation or qualifying home health services when its requirements are met. It doesn't pay simply because someone needs ongoing help with activities of daily living or supervision because of cognitive impairment.

That's why Medicare shouldn't be confused with a plan for paying for long-term care.

Medicare and Medicaid Are Not the Same

Part of the confusion may come from the similar names. Medicaid is a separate federal-state program and is the nation's largest payer of long-term services and supports. It can pay for nursing home care and, depending on the state and program, home- and community-based services.

But Medicaid is means-tested. Applicants must meet their state's financial and functional eligibility requirements. Income and asset rules vary by state, and protections can apply to spouses and certain assets.

People with significant savings generally cannot simply turn to Medicaid and expect the program to pay for long-term care while preserving all their assets. There is an important exception that many consumers don't know about.

Qualified Long-Term Care Partnership policies are available in most states. These policies can provide dollar-for-dollar asset disregard if someone later exhausts the policy's benefits and applies for Medicaid long-term care benefits.

For example, if a Partnership-qualified policy paid $300,000 in benefits, the policyholder could receive $300,000 of Medicaid asset disregard, assuming all other eligibility requirements are met.

Partnership rules vary by state.

Long-Term Care Can Become a Major Retirement Expense

What you'll pay for long-term care depends heavily on where you live, the type of care you need, and how much help is required. Homecare, adult daycare, assisted living, memory care and nursing home care all have different costs. Prices can vary substantially even within the same state.

Use the LTC News Cost of Long-Term Care Services Calculator to see current and projected future costs for in-home care, adult daycare, assisted living, memory care, and nursing home care where you live.

How People Pay for Long-Term Care

• Long-Term Care Insurance. Long-Term Care Insurance helps pay for care at home, adult day care, assisted living, memory care, and nursing home care. Benefits from a tax-qualified Long-Term Care Insurance policy are generally received tax-free when federal requirements are met.

Most people who purchase long-term care coverage do so between ages 47 and 67, according to LTC News research. Health is an important factor because Long-Term Care Insurance is medically underwritten. Once someone already needs care, it's generally too late to purchase coverage.

Premiums for traditional policies are not guaranteed and can increase for an approved class of policyholders, although rate stabilization rules make today's policies rate stable. Benefit amounts, inflation options, elimination periods, and other features vary by policy.

Hybrid policies combine life insurance or an annuity with long-term care benefits. They work differently from traditional coverage and often include contractual premium or benefit guarantees.

The LTC News LTC Insurance Learning Center explains how Long-Term Care Insurance works and the options available.

• Personal savings and income. Some households must pay for care using their retirement income, savings, and investments. For those with substantial resources, self-funding could be a reasonable strategy; however, with IRMAA and other tax consequences, self-funding is often too expensive and doesn't address the burden on loved ones that many people in surveys consider a top priority.
• Medicaid. Medicaid can pay for long-term services and supports for people who meet their state's financial and functional eligibility requirements. Eligibility, covered services, and available care settings vary by state, but Medicaid is designed for those with limited financial resources.

Make Long-Term Care Part of Retirement Planning

Long-term care planning doesn't mean assuming you'll end up in a nursing home. Most people want to stay home as long as possible, and most Long-Term Care Insurance claims start at home. The real question is how you would pay for help when you need it, and how that need could affect your income, savings, and family. Don't assume it won't happen, and don't assume the government will pay. Get professional guidance in long-term care planning as part of your comprehensive retirement plan.

Planning while you're younger and healthier provides more choices. Waiting until a health crisis leaves fewer options.

Loved One Needs Care? Get Help Now

If a loved one already needs care, or soon will, the LTC News Caregiver Directory can help you find in-home care, adult day care, assisted living, memory care, and other services. Families with an existing Long-Term Care Insurance policy can also get free assistance from LTC News with the claims process. LTC News partners with Amada Senior Care to provide help with no cost or obligation — File a Long-Term Care Insurance Claim.

Long-term care is one of the major financial and family risks of aging. Medicare can play an important role in your healthcare, but it shouldn't be mistaken for a long-term care plan.