By Marc Gilman
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Key Takeaways
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More than half (56%) of Americans turning 65 will develop a disability serious enough to require long-term care, according to federal microsimulation modeling — and the average projected lifetime LTSS cost is $120,900 in today’s dollars.
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Among people who actually use paid care, the average lifetime cost climbs to $245,400. About 14% of everyone turning 65 will pay at least $100,000 out of pocket for care over their lifetime.
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There are two credible federal estimates of lifetime LTC risk, and they don’t agree — for good reason. An earlier HHS-funded study using historical survey data put the figure at 70%; a newer HHS-funded study using population modeling puts it at 56%. Both are legitimate; they simply measure the question differently.
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Unpaid family caregiving is worth more than all paid care combined. The average value of unpaid care provided to someone with significant disabilities is $91,900 — and $204,000 among families who actually provide it, valued at a home care worker’s wage.
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A third framework, from Boston College’s Center for Retirement Research, breaks “need for care” into level and duration together — roughly 20% of retirees will need no assistance at all, 25% low-intensity help, 37% moderate needs, and 20% extensive needs like dementia care.
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Most people don’t know what care actually costs, or that Medicare won’t pay for it. A 2022 KFF survey found 45% of adults 65+ mistakenly believe Medicare covers long-term care, and most can’t correctly estimate real costs — 2023 medians ran $116,800 for a nursing home, $75,500 for home health aides, and $64,200 for assisted living.
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Being unmarried, being a woman, or having lower income all independently increase both the likelihood and the cost of needing paid care — the data breaks this down precisely, not just anecdotally.
Why Two Federal Studies Give Different Numbers
Two separate research efforts, both funded by HHS’s Office of the Assistant Secretary for Planning and Evaluation (ASPE) and both authored in part by economist Richard Johnson, have tackled this question with different methods:
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The 2017 study (Johnson, Urban Institute) used actual historical survey data — the Health and Retirement Study — tracking real people from 1995 to 2014 and calculating survival-curve probabilities. It found that 70% of adults who survive to 65 develop severe LTSS needs before they die, and 48% receive some paid care.
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The 2022 study (Johnson and Dey, Urban Institute/ASPE, revised August 2022) uses a microsimulation model called DYNASIM4, which projects forward from current demographic and economic data rather than looking backward at historical outcomes. It estimates that 56% of Americans turning 65 today will develop a significant disability, with an average LTSS need lasting 3.1 years.
Neither number is wrong. They’re answering slightly different questions with different tools — one measures what already happened to real people over two decades; the other projects what’s likely to happen to people turning 65 now, based on a demographic and economic model calibrated to current trends. If you want a range rather than a single number: current federal research suggests something between roughly 56% and 70% of people who reach 65 will develop a disability serious enough to need long-term care.
What It Actually Costs
This is the part most lifetime-risk statistics leave out entirely, and it’s arguably the more useful number for planning purposes. Per the 2022 ASPE brief:
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Average projected lifetime LTSS cost, across everyone turning 65: $120,900 (2020 dollars), from age 65 through death.
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Average cost among people who actually use paid care: $245,400.
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Medicaid covers the largest share (43%, averaging $51,800), followed by family out-of-pocket costs (37%, averaging $44,800), other public programs (15%), and private insurance (just 5%, averaging $6,000).
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14% of everyone turning 65 will pay at least $100,000 out of pocket for long-term care over their remaining lifetime.
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Costs are meaningfully higher for women: $154,300 on average, compared with $85,400 for men — a direct result of women’s longer life expectancy and greater exposure to care needs.
For a more immediate, year-by-year sense of cost, a separate Boston College analysis (Munnell, 2025) cites 2023 median annual costs by care setting: $116,800 for a private nursing home room, $75,500 for home health aides, and $64,200 for assisted living. That same analysis found that only about 15% of adults 65 and older carry private long-term care insurance — and just 3% of all U.S. adults overall.
Unpaid Care Has Real, Measurable Value
One of the more striking findings: valuing unpaid family caregiving at the median wage of a paid home care worker, the average value of unpaid care provided to someone with significant disabilities is $91,900 — and $204,000 among families who actually provide it. That’s more than the average cost of all paid LTSS combined. Without that unpaid contribution from family and friends, both individual out-of-pocket costs and public program spending would be substantially higher than the figures above already show.
Who Faces the Highest Risk and Cost
The 2022 model breaks down both incidence and duration by personal characteristics with more precision than most public discussion of this topic:
Gender. 64% of women are projected to develop a significant disability, with an average duration of 3.6 years, compared with 49% of men averaging 2.5 years. Among women who do develop needs, 26% will need care for more than five years, versus 18% of men.
Marital status. Unmarried people at age 65 are projected to need more paid care than married people — an average of 1.0 years of paid care, compared with 0.7 years for married people. That gap reflects the reality that a spouse is often the first line of unpaid caregiving; without one, paid care starts sooner.
Income. People in the lowest income quintile at 65 face both higher incidence (63% will develop significant disability) and longer average duration (3.8 years) than people in the highest quintile (54% incidence, 2.8 years). The lowest-income group is also far more likely to need more than five years of care (29%, versus about 20% for higher-income groups).
Health status at 65. Perhaps counterintuitively, self-reported health at 65 doesn’t cleanly predict outcomes — people who rated their health “excellent” at 65 weren’t dramatically less likely to eventually need paid care than those in fair or poor health, since conditions like dementia can develop regardless of earlier physical health.
A Third Lens: Level and Duration of Care Together
Both ASPE studies answer “will you need care” with a single percentage. Researchers at the Center for Retirement Research at Boston College (Anek Belbase, Anqi Chen, and Alicia Munnell) took a different approach in a widely cited 2021 analysis, cross-referencing both the intensity and the duration of care needs at age 65:
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About 20% of retirees will need no assistance at all during their remaining lives.
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About 25% will have low-intensity needs — help with an instrumental activity like money management, cooking, or shopping, but not personal care.
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About 37% will have moderate needs — assistance with an actual activity of daily living, such as bathing or toileting.
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About 20% will have extensive needs — dementia, or assistance with two or more activities of daily living.
That framework matters because “will I need long-term care” isn’t really a yes/no question in practice — a retiree needing occasional help with grocery shopping faces a very different planning problem than one with dementia needing round-the-clock supervision, even though both technically “need care.”
The same research also found that individual factors compound in ways worth being direct about: being married, more educated, and in better health at 65 are all independently associated with lower long-term care risk — and the research notes plainly that these protective factors tend to run in the opposite direction from the ability to pay for care privately, which is a real equity tension in how LTC risk and LTC financing capacity are distributed across the population.
A Literacy Gap Worth Addressing Directly
A 2024 survey (Greenwald Research, for the Center for Retirement Research) found that despite the scale of this risk, long-term care ranks low on most pre-retirees’ list of financial worries — and most don’t actually know what care costs. Only 39% of respondents could correctly estimate nursing home costs, 34% for home care, and just 15% for assisted living. Perhaps most strikingly, a separate 2022 KFF survey found that 45% of adults 65 and older believe Medicare will cover their long-term care if needed, and another 9% believe private health insurance will. Neither is generally true — Medicare doesn’t cover custodial long-term care, and ordinary health insurance doesn’t either. That gap between perception and reality is arguably a bigger risk than the underlying statistics themselves.
What This Means for Planning
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A single “lifetime risk” percentage is less useful than the cost distribution. Whether the right number is 56% or 70%, the more actionable question is: could your household absorb $120,900 in average costs, or $245,400 if care is actually needed — and do you know which end of that range your own situation might land on?
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“Average” hides a wide range. Some people will need no paid care at all; others will need $250,000 or more. Planning around the average alone underprepares for the tail risk that actually causes financial hardship.
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Marital status changes the math, not just emotionally but financially. If you’re unmarried or expect to be widowed, your paid-care exposure is measurably higher than a married household’s, on average.
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Unpaid care isn’t “free” — it has a real cost, just not always a financial one to the person paying it. Leaning on family caregiving reduces your own out-of-pocket exposure, but it’s worth being honest about what that actually asks of the people providing it.
Questions Worth Asking
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If your household needed to cover $120,900 in average lifetime LTC costs — or $245,400 if care is actually used — where would that money come from?
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Are you married, and if so, have you and your spouse discussed what happens to each of you individually if the other needs extended care first?
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Does your current income and asset picture put you closer to the group that qualifies for Medicaid support, or closer to the group paying substantially out of pocket?
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Has your family history of dementia or cognitive decline factored into your planning, given that health status at 65 doesn’t reliably predict this specific risk?
What To Do Next
If these numbers change how you’re thinking about your own long-term care exposure, let’s talk through what options actually exist — including hybrid life insurance/LTC policies, standalone LTC coverage, and how these fit alongside your broader retirement and estate plans.
Questions? Call (800) 927-9326 or email
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Sources: Richard W. Johnson, “What Is the Lifetime Risk of Needing and Receiving Long-Term Services and Supports?” HHS/ASPE, prepared by the Urban Institute (April 2017), based on Health and Retirement Study data from 1995–2014; Richard W. Johnson and Judith Dey, “Long-Term Services and Supports for Older Americans: Risks and Financing, 2022,” HHS/ASPE Research Brief (August 2022, revised), based on Urban Institute DYNASIM4 microsimulation modeling; Anek Belbase, Anqi Chen, and Alicia H. Munnell, “What Level of Long-Term Care Services and Supports Do Retirees Need?” Center for Retirement Research at Boston College (2021); Alicia H. Munnell, “Most Adults Greatly Underestimate the Realities of Aging and Long-Term Care,” MarketWatch/Center for Retirement Research at Boston College (March 2025), citing Greenwald Research survey data (July 2024) and KFF survey data (2022).
This article is for general educational purposes. Cited figures reflect two different federal research methodologies with different data vintages and assumptions; actual individual outcomes vary widely. This is not a recommendation regarding any specific product or carrier, and is not medical, financial, or legal advice. Consult a licensed advisor for guidance specific to your situation.
