A semi-private nursing home room carried a median price of $315 a day in 2025, or $114,975 for a full year, according to the 2025 Cost of Care Survey that CareScout, a Genworth Financial subsidiary, released in March 2026. A private room ran $355 a day, or $129,575 annually. Both figures rose only 1% to 2% over 2024, a sharp slowdown after years of double-digit increases across long-term care settings. That deceleration offers little relief for retirees, because Medicare — the program most people assume will cover a nursing home stay — pays for almost none of it.
The Medicare Gap Behind the Bill
Medicare Part A covers skilled nursing facility care only after a beneficiary has a qualifying inpatient hospital stay of at least three consecutive days, and even then the benefit is capped at 100 days per benefit period, according to Medicare’s own coverage guidance. For 2026, an enrollee owes the $1,736 Part A deductible and nothing more for days one through 20; days 21 through 100 carry a $217 daily coinsurance; and every day beyond the hundredth is billed entirely to the patient or a secondary payer.
The distinction that trips up many families is the difference between skilled and custodial care. Medicare’s 100-day benefit exists for rehabilitation after an acute medical event — physical therapy following a hip fracture, wound care after surgery — delivered by licensed nursing or therapy staff under a doctor’s order to help a patient improve or avoid decline. The CareScout survey prices an entirely different kind of stay: the ongoing, day-to-day custodial care a resident needs indefinitely once therapy ends and no further clinical improvement is expected. Medicare does not cover that stay in any amount, for any length of time, regardless of a beneficiary’s income or how many Part A benefit periods remain.
The confusion is widespread enough to show up in national survey data: about four in ten adults, per polling that health policy researcher KFF has tracked on long-term care financing, incorrectly identify Medicare, rather than Medicaid, as the primary source of nursing home coverage for low-income residents. That misunderstanding leaves many households unprepared for a bill that runs to six figures a year with no federal insurance program standing behind it.
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A Year of Rare Deceleration in Long-Term Care Pricing
Nursing homes were not the only setting where price growth cooled in 2025. CareScout’s survey, which collected more than 25,000 provider rates nationwide between July and November of that year, found the national median cost of a non-medical, in-home caregiver rose 3% to $35 an hour, or $80,080 annually assuming 44 hours of care a week. Assisted living communities rose 5% to $6,200 a month, or $74,400 a year — a marked slowdown from the double-digit percentage increase the same survey recorded in 2024.
Adult day health care was the lone category to get cheaper, falling 5% to a median $95 a day, or $24,700 a year based on five days of weekly use — a decline CareScout attributed largely to Medicaid reimbursement rates, which function as a price benchmark in many local markets. Skilled nursing delivered directly in a home, newly tracked in the 2025 survey as private-duty nursing, carried a median hourly rate of $90 and a per-visit rate of $160, pricing that reflects the advanced clinical training the role requires compared with non-medical caregiving. Utilization of the two rate structures varies by medical need, with per-visit pricing generally covering brief, task-based services and hourly rates covering longer or ongoing skilled needs.
Samir Shah, CareScout’s chief executive, framed this year’s smaller increases as one data point among several that families weigh, not evidence that long-term care has become affordable. “Long-term care remains one of the most significant financial challenges individuals and their families face as they age,” he said in the release accompanying the survey. A median annual price of $114,975 for a shared nursing home room, even growing at a fraction of the double-digit rates recorded in prior years, remains a bill few household retirement accounts are built to absorb without drawing down principal quickly.
The Medicaid Spend-Down Waiting on the Other Side
Once a household’s income and assets are exhausted paying nursing home bills at those rates, Medicaid becomes the backstop. Medicaid was the primary payer for more than six in ten of the 1.2 million people living in nursing facilities nationwide as of July 2024, according to KFF’s most recent analysis of nursing facility financing — a share that has stayed roughly constant even as the total number of nursing home residents has fallen over the past decade.
The mechanism behind that backstop is a spend-down: to qualify for Medicaid coverage of nursing facility care, a resident generally must first deplete income and countable assets to the eligibility limits set by their state, a process many families begin only after private payments have already drained tens of thousands of dollars from savings. Medicaid financed 44% of the $147 billion the United States spent on institutional long-term care in 2023, according to the same KFF analysis — money that flows through state Medicaid programs and their fee-for-service and managed-care payment systems, not through Medicare, Social Security, or a retiree’s own investment accounts.
That structure means the CareScout numbers describe two different financial events for two different populations: a market price for those who can pay privately, and a countdown toward Medicaid eligibility for nearly everyone else. The 2% and 1% increases CareScout recorded this year change the pace of that countdown only slightly. They do not change the fact that Medicare — built to pay hospital and physician bills — was never designed to cover the kind of custodial stay a $114,975-a-year nursing home bill actually represents.
This article was researched and drafted with the assistance of artificial intelligence.
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