2025 costs in California
| California median, 2025 | Per year | Per month |
|---|---|---|
| Home care aide, 44 hours a week | $91,520 | $7,627 |
| Assisted living, private one-bedroom | $82,800 | $6,900 |
| Nursing home, semi-private room | $146,000 | $12,167 |
| Nursing home, private room | $182,135 | $15,178 |
| Adult day health care, 5 days a week | $24,440 | $2,037 |
Source: CareScout 2025 Cost of Care Survey, released March 2026. Monthly figures are the annual median divided by twelve.
For comparison, the national median for assisted living was $74,400 a year and a semi-private nursing home room was $114,975. California is one of the more expensive states for every type of care, and the Bay Area sits at the high end of California.
How likely you are to need it
According to the federal government’s long-term care planning site, someone turning 65 today has close to a 70 percent chance of needing some type of long-term care during their life. Many will need only a few months of help at home. A smaller group needs years of care, and that group is where retirement plans break.
What Medicare and Medi-Cal pay
Medicare covers short stays in a skilled nursing facility after a qualifying hospital stay, up to 100 days, with a daily copay after day 20. It does not pay for custodial care, the help with bathing, dressing and eating that makes up most long-term care.
Medi-Cal can pay for nursing home care for people who qualify. Its eligibility rules changed in 2024 and again for 2026, so check the current rules with a Medi-Cal planning attorney before counting on it.
The main ways families pay for care
Paying from savings
Works if the plan has room for it. Three years in assisted living at today’s California median is about $250,000 before price increases, and that money comes out while the healthy spouse still needs income.
Traditional long-term care insurance
Pays a daily or monthly benefit when you need help with daily activities. Premiums are lower when you buy younger and healthier, and they can rise over time.
Hybrid life insurance or annuities with a care benefit
A life insurance policy or annuity that lets you draw the benefit early for long-term care. If you never need care, the money still goes to your heirs or stays in the annuity. These usually cost more up front than a traditional policy and the trade-offs are worth comparing line by line.
Home equity and family
Many Bay Area families have most of their wealth in the house. A plan for care should say whether the house is part of the answer, and what happens to the spouse who stays in it.
What I look at with clients
I add a care event to the plan, usually two to three years of assisted living or home care starting in your early eighties, and look at what it does to the surviving spouse’s income. Then we decide whether to self-fund, insure, or use a mix.
Questions people ask
Does Medicare pay for long-term care?
Not for ongoing custodial care. Medicare covers up to 100 days in a skilled nursing facility after a qualifying hospital stay, with a daily copay after day 20, and limited home health care. Help with daily activities over months or years is not covered.
When should I look at long-term care insurance?
Many people look in their 50s or early 60s. Premiums are lower and approval is easier while you are younger and healthy, and some health conditions make coverage unavailable later.
How much is home care per hour in the Bay Area?
CareScout’s 2025 California median for a non-medical home care aide works out to about $40 an hour ($91,520 for 44 hours a week, all year). Agencies in the Bay Area often charge more, and many have a minimum number of hours per visit.
Sources
Pete Alexander plans retirement income, asset protection and insurance for families in Fremont and the East Bay, and co-wrote Crash Proof Wealth with Brett Kitchen. More about Pete.
This guide is general information. It is not tax, legal or investment advice or a recommendation to buy any product. Figures and rules were checked on October 25, 2026 and can change. Talk with a qualified professional about your own situation.