Most Americans who live to age 65 will need some form of long-term care, according to federal health policy research. The issue is especially significant for Medicare beneficiaries, because the program says it generally does not pay for the non-medical, day-to-day support that makes up most long-term care.
Federal estimates put the need at 70% after age 65
A widely cited estimate from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation found that 70% of adults who survive to age 65 develop severe long-term services and supports needs before they die. That finding appeared in the federal research report “What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports?” published April 11, 2019.
The report drew on longitudinal data from the Health and Retirement Study and measured needs such as help with basic daily activities, including bathing, dressing and eating. The same analysis found that 48% of adults who survive to 65 receive some paid care over their lifetime, showing that family caregiving and unpaid support still play a major role alongside formal services.
Federal aging agencies use similar planning guidance for consumers. The Administration for Community Living says Medicare only pays for long-term care in limited situations involving skilled services or rehabilitative care, not the non-skilled assistance with activities of daily living that makes up most long-term care.
Medicare states plainly that long-term care, also called custodial care or long-term services and supports, is not covered when it consists mainly of non-medical assistance. On its coverage guidance, Medicare says most long-term care helps with personal tasks such as dressing, bathing, using the bathroom, meal delivery, adult day health care and transportation, and that beneficiaries pay all costs for non-covered services.
That policy applies whether care is provided at home, in the community, in assisted living or in a nursing home, unless the person qualifies for a narrower Medicare-covered benefit. Medicare does cover some short-term skilled nursing facility care and some home health services, but those benefits are tied to medical need and specific conditions, not ongoing custodial support alone.
Medicare also says Medigap plans do not cover long-term care. For nursing homes specifically, Medicare says it generally does not cover long-term care stays, even though it may still cover hospital care, physician services, prescription drugs and certain medical supplies for someone living in that setting.
The financial stakes are substantial. KFF reported this month that in 2025 the median annual cost of full-time non-medical caregiver services in the United States was $80,080, while a private room in a nursing home cost $129,575 and round-the-clock home health aide services reached $305,760.
CareScout, which released its 2025 Cost of Care Survey results in March, reported similar national median figures, including $35 an hour for non-medical caregiver services, $6,200 a month for assisted living, $315 a day for a semi-private nursing home room and $355 a day for a private room. Those figures show why even a limited period of care can quickly outpace retirement income.
For many households, the practical meaning is straightforward: Medicare can remain essential for hospital, physician and other covered medical care, but it is not a financing solution for most long-term personal care needs. Federal guidance says people may instead rely on Medicaid if they meet state eligibility rules, private long-term care insurance, personal savings, or unpaid help from family and friends.