Most retirement plans stop at the end of the paycheck. The math handles a monthly budget, Social Security claim age, withdrawal rate, and maybe early travel. What follows, when someone needs help dressing, cannot be left alone, or moves to memory care, tends to be a footnote. That stretch holds the biggest bills of a lifetime, and roughly 70% of adults reaching 65 will use some form of long-term services and supports before it ends. The question worth working through before retirement is what the last decade actually costs and whether a portfolio can absorb it without collapsing the surviving spouse’s standard of living.
What the Care Phase Actually Costs
Medicare pays for much but not custodial care, the help with bathing, meals, and dressing that defines late-stage dementia and frailty. The 2026 standard Part B premium is $202.90 per month with a $283 annual deductible. Part A carries a $1,736 inpatient hospital deductible, and skilled nursing facility coinsurance runs $217 per day for days 21 through 100. After day 100, Medicare stops paying for the facility.
The national numbers from the 2025 CareScout Cost of Care Survey tell a sobering story. Assisted living runs $6,200 a month on average, or roughly $74,400 a year. A home health aide working 44 hours a week will set you back $77,792 annually. For a semi-private nursing home room, the daily rate is $315, or about $114,975 per year. Private rooms and memory care units are even more expensive. The real unknown is how long care will actually be needed. Many situations last one to three years, but dementia typically runs four to eight years from diagnosis. A ten-year care horizon is not the norm, but it happens often enough that you cannot responsibly ignore it when planning.
Turning a Care Decade Into a Portfolio Number
Working assumption: one spouse enters assisted living at 80, transitions to memory care three years later, and dies at 90. Three years of assisted living at $74,400 totals roughly $223,000. Seven years of nursing or memory care at $115,000 totals roughly $805,000. Layer on Medicare premiums, a Medigap policy (typical premiums run in the low hundreds a month), Part D, dental, and out-of-pocket drugs, and add another $60,000 to $80,000 across the decade for the person in care. The all-in bill comes to about $1.1 million in current dollars for one spouse.
Income offsets can take a real bite out of these daunting numbers. The average retired-worker Social Security benefit in January 2026 runs about $2,071 a month, and when you add two benefits together, they typically cover $45,000 to $55,000 a year. That means your portfolio only needs to fill whatever gap remains.
If you are drawing at a conservative 3.5% withdrawal rate from a dedicated care sleeve, covering a $75,000 annual shortfall for a full decade would require roughly $1.5 million set aside specifically for care, and that is before you even touch the lifestyle portfolio the couple needs to live on. That lifestyle number, $1.26 million according to the 2025 Northwestern Mutual survey, is really just a starting point for ordinary retirement, not the endgame you should be planning for.
Survivor Income Cliff Most Plans Miss
When the higher-earning spouse dies, the survivor keeps the larger of the two Social Security checks, not both. Household income can drop by $18,000 to $25,000 a year at the exact moment care spending peaks (the survivor-benefit sequencing decisions couples need to make before 70 are the whole subject of a free guide we put together here: Widow’s Math).
Federal Medicaid rules protect the community spouse to a point: in 2026, the Community Spouse Resource Allowance is capped at $162,660, with a maximum monthly maintenance needs allowance of $4,066.50. The rest of the couple’s assets must be spent down before Medicaid picks up nursing home costs, and the five-year lookback penalizes transfers made after the wheels start turning.
The tax side of this equation flips a common assumption on its head. Withdrawing $150,000 a year from a traditional IRA to pay for a nursing home generates a large medical expense deduction that can offset most of the tax on that withdrawal, which means late-life pre-tax balances are actually less punishing than they appear at age 65. That said, aggressive Roth conversions in early retirement years can push MAGI into IRMAA tiers that reach $689.90 per month for Part B, and that surcharge lingers for two years after the conversion. Sequence matters enormously here, and inflation only compounds the problem. The 2027 Social Security COLA is tracking near 3.1%, while care inflation has historically run faster than headline CPI, which sat at 332.8 in July 2026.
Putting a Number on It, in Plain Dollars
For a couple determined to fund a full decade of care without leaving the survivor impoverished, a realistic total lands in the $2.5 to $3 million range in current dollars. That breaks down to roughly $1.2 to $1.3 million for a lifestyle portfolio, plus a care reserve of $1.5 to $1.7 million held in something that resists inflation, such as a Treasury ladder, I Bonds currently earning a 4.26% combined rate, or a hybrid life and long-term care policy purchased in the late 50s to early 60s. Not every couple will face ten years of paid care, of course.
A paid-off home can absorb some of the load through a reverse mortgage or a sale into assisted living. Insurance bought early transfers a piece of the tail risk. The last ten years can cost more than the first twenty of retirement combined, and any plan that budgets a flat $60,000 a year through age 90 is really budgeting for a retirement that ends healthy at 79, not the one that actually arrives.
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