By the Cornerstone Wealth Management Team
If you’re like many of our wealth management clients, you’ve done the work on income, taxes, and Medicare, and long-term care planning is the piece that keeps getting pushed to next year. There’s a reason for that. Nobody can tell you in advance whether you’ll need care, how long it would last, or what it would cost, which makes it a hard question to plan around when every part of it is unknown.
The trouble is that long-term care is one of the few retirement expenses large enough to reshape everything else in your plan, and the ways you can pay for it narrow as you get older.
Useful long-term care planning starts with three things you can know today: what care costs in your area, what your current coverage does and doesn’t do, and which funding paths remain open at your age and health.
What Long-Term Care Means in Practice
Long-term care is help with everyday personal tasks rather than medical treatment, activities such as bathing, dressing, eating, getting from a bed to a chair, and managing medications. Insurance companies call these activities of daily living, and most policies begin paying benefits when someone needs help with at least two of them, or when a cognitive condition such as dementia is diagnosed.
That care can arrive in several settings. Some people receive it at home from a paid aide, some move to an assisted living community, some need memory care, and some end up in a nursing home. Most care starts at home and escalates from there.
Medicare Stops Short of Covering It
Medicare pays for skilled nursing care on a short-term basis, and only after a qualifying inpatient hospital stay. Coverage runs up to 100 days per benefit period. The first 20 days are covered in full, a daily coinsurance amount applies from day 21 through day 100, and after that Medicare pays nothing toward the stay.
Custodial care sits outside that entirely. Help with bathing and dressing, repeated daily for months or years, is the kind of care many retirees eventually need, and Medicare wasn’t designed to cover it. Families often learn this during a hospital discharge conversation, which is the worst possible moment to learn it.
What Care Costs in Nevada and Nationally
Recent national medians put assisted living at about $6,386 a month and a private nursing home room around $366 a day. In-home aide help runs close to $36 an hour, which sounds manageable until you multiply it across a schedule that grows from a few hours a week to most of the day. Communities across the Las Vegas Valley vary considerably by care level and amenities.
Run those numbers against a two- or three-year care event and you can see how this line item differs from other retirement expenses.
Four Ways Retirees Pay for Care
Most households end up using some combination of these:
- Self-funding. Paying from savings, investment income, or a dedicated reserve. This is the default for many families with substantial assets, and it works ideally when the amount set aside has been sized deliberately rather than assumed.
- Traditional long-term care insurance. Pays a benefit when you need care. Premiums can increase over time, and the policy only pays if care is required.
- Hybrid policies. Life insurance or an annuity with a long-term care benefit attached. If care isn’t needed, unused value may pass to heirs. These typically cost more up front.
- Medicaid. Available after assets have been spent down to state limits, with a five-year look-back on transfers. This is a last resort for most of our clients, though it becomes relevant in extended care situations.
Why Age and Health Set Your Options
Long-term care insurance requires medical underwriting, which means an insurer reviews your health history before offering coverage. Premiums climb with age, and applicants are more likely to be declined as health conditions accumulate. Waiting can therefore reduce the number of options available to you later.
This is why long-term care planning belongs in your late 50s and early 60s rather than after a diagnosis. Even if you decide to self-fund, making that choice deliberately at 60 gives you a decade to build the reserve.
How Long-Term Care Affects the Rest of Your Plan
A care event moves through your whole plan. Large withdrawals to cover care can push you into a higher tax bracket, and that higher income can raise your Medicare premiums two years later through the income-related surcharge. Premiums for tax-qualified policies may count as medical expenses, subject to age-based caps and the threshold for medical deductions.
For married couples, the effect reaches further. A care event affecting one spouse can reduce what’s available to the surviving spouse for the rest of their life, and home equity, beneficiary designations, and legacy goals all shift alongside it.
Long-term care planning done well means making a connected set of choices about income, taxes, housing, and what you want to leave behind.
Start the Conversation
Long-term care is the part of retirement planning where early decisions carry the most weight, because the options available at 58 differ from those available at 68. You don’t need certainty about the future to make progress. What helps is a clear read on what care costs in your area, what your current plan would absorb, an which paths remain open to you today.
If you’d like to talk through how long-term care fits into your broader retirement strategy, schedule a complimentary call with our team. We can help you understand where you stand and what questions to ask next.
Let us help you get started. Schedule a complimentary call today by calling (702) 342-0781 or emailing scheduling@cornerstonevegas.com.
Frequently Asked Questions
Does Medicare cover long-term care?
No. Medicare covers short-term skilled nursing care after a qualifying hospital stay, up to 100 days per benefit period, with daily coinsurance applying from day 21 onward. It doesn’t pay for custodial care, meaning ongoing help with bathing, dressing, or eating, which is the type of care most retirees eventually need.
How much does long-term care cost per year?
Costs vary by setting and location. Recent national medians run near:
- Assisted living: about $6,386 per month
- Nursing home, private room: about $366 per day
- In-home aide: about $36 per hour
Nevada pricing tracks close to national figures, though Las Vegas Valley communities vary widely by care level.
When should I start planning for long-term care?
Most people begin between ages 55 and 65. Medical underwriting drives that timing, since insurers review health history before offering coverage, and both premiums and declines rise with age. At Cornerstone Wealth Management, we help Henderson and Las Vegas retirees evaluate long-term care alongside their income, tax, and legacy planning.
What’s the difference between traditional long-term care insurance and a hybrid policy?
Traditional policies pay only if you need care, and premiums can rise over time. Hybrid policies pair life insurance or an annuity with a long-term care benefit, so unused value may pass to heirs. Hybrids usually cost more up front and generally don’t qualify for the same premium tax treatment.
How do people pay for long-term care without insurance?
Four approaches are common:
- Self-funding from savings or investment income
- Home equity, through a sale or a line of credit
- Family caregiving, which converts cost into time
- Medicaid, which requires spending assets down and applies a five-year look-back
Many retirees with substantial assets use a blend of these.
About Cornerstone Wealth Management
Cornerstone Wealth Management is a fiduciary wealth management firm based in Henderson, Nevada, helping retirees and pre-retirees nationwide plan for their future with clarity, confidence, and care. Co-founded by Jammie Avila, Kyle Kirwan, and Anthony Napolitano, the firm takes a comprehensive approach that unites income, investment, tax, healthcare, insurance, and legacy planning under one roof—simplifying complex financial decisions so clients can focus on what matters most.
Disclosures: Registered Representatives offer securities through Independent Financial Group, LLC (IFG), Member FINRA/SIPC. Investment Advisor Representatives offer Advisory services through Independent Financial Group, LLC (IFG), a Registered Investment Adviser.
Cornerstone Wealth Management, Cornerstone Tax Advisory and IFG are unaffiliated entities.
The foregoing content was prepared by Indigo Marketing Agency with verbiage, opinions and/or financial commentary input provided by Cornerstone Wealth Management.
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