What If One of Us Needs Long Term Care? What Wichita Couples Should Figure Out Before Age 65

If you’re married and getting close to retirement, there are many questions you need to answer. However, I believe one is particularly difficult:

What happens if one of us can’t take care of ourselves anymore?

That could mean help bathing, getting dressed, eating, or moving around the house.

Maybe it means memory care. Maybe one spouse can stay home, but only with someone coming in every day to help.

Someone has to provide that care. And someone has to pay for it.

Does Medicare pay for long term care?

Usually, no.

Medicare can pay for short term skilled nursing or rehabilitation under specific conditions. Medicare Part A can cover up to 100 days in a skilled nursing facility during a benefit period, but coverage depends on continuing to meet Medicare’s requirements for skilled care.

Medicare generally does not pay for ongoing custodial care, which is the help people need with things like bathing, dressing, eating, and getting around. (Medicare: Nursing Home Coverage)

That distinction is important because custodial care is what many people eventually need.

The U.S. Department of Health and Human Services estimates that someone turning 65 has almost a 70% chance of needing some type of long term care services during their remaining lifetime. (Administration for Community Living: How Much Care Will You Need?)

That number sounds terrifying, so it needs some context.

It does not mean 70% of us are destined to spend years in a nursing home. HHS estimates that about 65% of people receive some care at home. About 35% use nursing facility care at some point. (Administration for Community Living: How Much Care Will You Need?)

So the problem can look very different from one family to another.

What does long term care cost?

This is where the rubber meets the road.

CareScout’s 2025 Cost of Care Survey put the national median cost of nonmedical care at home at roughly $80,000 per year, based on 44 hours of care per week. Assisted living was roughly $74,000 per year. A private nursing home room was roughly $130,000 per year. (CareScout: 2025 Cost of Care Survey)

One year is a lot of money. 3 or 5 years can materially change a retirement plan that doesn't account for this expense.

And for a married couple, I think that is the part that deserves more attention. The financial problem is not simply paying for the spouse who needs care. You still have another spouse who needs a home, groceries, transportation, healthcare, and enough money to live for potentially decades.

A plan that can pay for Dad’s nursing home but leaves Mom scared to spend $50 at Dillons is a bad plan.

So how are you going to pay for it?

There isn’t one answer.

Some Wichita couples have enough money that self funding some or all of their care may make sense. Some may want to consider traditional long term care insurance. Others may look at policies that combine life insurance with long term care benefits.

Insurance has trade offs. It costs money. Benefits have limits. Medical underwriting could affect things, and waiting until your health changes can take some choices off the table.

Family is another possibility. But I would be careful about building your entire plan around your spouse or kids becoming caregivers.

Your 68 year old spouse may desperately want to take care of you and physically be unable to do it. Your adult children may live 600 miles away, have jobs, kids, and mortgages of their own.

“We’ll figure it out” leaves an awful lot for them to figure out.

Medicaid can also pay for long term care for people who qualify, but the rules are more complicated than simply spending every dollar until you are broke. Eligibility depends on financial and care requirements, and special Medicaid rules protect some income and assets for a spouse who remains at home. (Medicaid: Spousal Impoverishment)

For most couples approaching retirement, it is useful to consider this well before any

Medicaid application.

The conversation I want Wichita couples to have before they need care

Where would you want to receive care if you had a choice?

How much help are you assuming your spouse can provide?

What are you assuming your kids will do?

Could your retirement plan absorb $70,000, $80,000, or $100,000 of care for several years without creating a serious problem for the other spouse?

And if insurance is going to be part of the answer, when are you going to make that decision?

You don’t have to predict whether either of you will eventually need care. Nobody can.

But you can decide what you would want to happen and figure out whether the money is there to support it.

If one of you needed $80,000 to $100,000 of care next year, where would that money come from?

And what would happen to the spouse who was still at home?

Let's Talk