Nursing home care is the single most expensive thing most American families ever buy, and almost nobody prices it before they need it. The decision usually arrives during a hospital discharge, with three days to choose a facility and no idea what the monthly bill will be.
This guide gives you the 2026 numbers: the national median monthly and daily rate for both room types, the state-by-state spread (which is enormous), what the daily rate does not include, and the payer rules that decide whether you write a check for $9,581 a month or almost nothing. CareScout, which has run the industry’s benchmark cost survey since 2004, estimates that 7 out of 10 people will need long-term care at some point.
What Does a Nursing Home Cost Per Month?
The 2025 CareScout Cost of Care Survey, published in March 2026 and current as of this writing, puts the national median at $9,581 per month for a semi-private (shared) room and $10,798 for a private room. Expressed as a daily rate, which is how facilities actually bill, that is $315 and $355 per day.
The survey collected more than 25,000 rates from providers nationwide between July and November 2025, including 4,425 completed nursing home surveys across all 50 states.
| Service/Type | Low | Average | High |
|---|---|---|---|
| Semi-private room, per month | $5,627 (TX) | $9,581 | $27,831 (AK) |
| Semi-private room, per day | $185 | $315 | $915 |
| Semi-private room, per year | $67,525 | $114,975 | $333,975 |
| Private room, per month | $7,604 (MO, TX) | $10,798 | $18,448 (OR) |
| Private room, per day | $250 | $355 | $606 |
| Private room, per year | $91,250 | $129,575 | $221,372 |
| Private vs. semi-private premium, per month | n/a | $1,217 | n/a |
| Assisted living, per month (for comparison) | $4,369 (MS) | $6,200 | $12,096 (HI) |
| Medicare SNF coinsurance, days 21-100 | n/a | $217/day | n/a |
The private-room premium is smaller than most families expect: $1,217 a month nationally, or about 13%. In several states the gap is wider, and in a few it nearly disappears.
Year over year, growth has cooled. The semi-private median rose 2% and the private median 1% in 2025, after several years of much steeper increases.
The State Spread Is the Biggest Variable
Nothing moves the number like geography. The semi-private median runs from $5,627 a month in Texas to $27,831 in Alaska, a five-fold difference for nominally the same service.
The most expensive semi-private markets after Alaska are Oregon ($16,760), New York ($15,528), Hawaii ($15,473) and Connecticut ($15,208). The cheapest after Texas are Missouri ($6,741), Oklahoma ($7,026), Arkansas ($7,452) and Louisiana ($7,604).
Private rooms rank differently. Oregon is the most expensive at $18,448 a month, followed by Connecticut and New York (both $16,729) and Hawaii ($16,395). Missouri and Texas tie for cheapest at $7,604. CareScout reported insufficient private-room data for Alaska.
The practical takeaway: if a parent lives near a state line, or if family is spread across regions, the county you choose can change the annual bill by six figures.
Skilled Nursing vs. Long-Term Custodial Care
This is the distinction that decides whether Medicare pays anything, and it is the one families most often get wrong.
A skilled nursing facility (SNF) stay is short-term. It follows a hospitalization, it requires daily skilled nursing or therapy that only licensed professionals can provide, and it has a rehabilitation or medical goal. Medicare Part A can pay for it.
Long-term custodial care is help with the activities of daily living: bathing, dressing, eating, transferring, toileting. There is no rehab goal. Medicare pays nothing toward it, no matter how medically necessary it is or how long you have paid Medicare taxes.
Both are frequently delivered in the same building by the same staff. The label on your stay, not the address, is what the payment rules follow. Ask the facility directly which one you are being admitted under, and ask again if therapy is discontinued, because that is often the moment a Medicare-covered stay converts to a private-pay stay.
What Medicare Actually Covers
For a qualifying SNF stay in 2026, Part A pays on this schedule per benefit period:
- Days 1 to 20: $0 per day after you have paid the Part A deductible of $1,736 (you do not pay it twice if you already paid it for the hospital stay in the same benefit period).
- Days 21 to 100: $217 per day. Run all 80 days and that is $17,360 out of pocket.
- Days 101 and beyond: you pay all costs.
To qualify you need a medically necessary inpatient hospital stay of at least three days in a row. Time spent under observation or in the emergency room does not count toward those three days even if you were there overnight, which is one of the most expensive fine-print rules in Medicare. Some Accountable Care Organizations and Medicare Advantage plans waive the three-day requirement, so ask before you assume.
Coverage also stops early if you stop needing daily skilled care. The 100 days are a ceiling, not an entitlement.
What Drives the Price
Room type. Semi-private to private is a $1,217 a month step nationally. Some facilities also offer a private suite tier above that.
State and metro market. Discussed above, and it dominates everything else.
Level of care. Many facilities price in tiers based on how much hands-on assistance a resident needs, with memory-care and ventilator units carrying separate rates. Our guide to memory care costs covers that pricing model in detail.
Ancillary charges. The basic daily rate covers room, meals, routine nursing and housekeeping. Facility admission agreements spell out what is billed on top. The admission agreement published by Morningside Nursing and Rehabilitation Center in the Bronx, a typical example, lists these as excluded from the daily basic rate: physician services, rehabilitation therapies, oxygen, dental and diagnostic services, laboratory, x-ray, podiatry, optometry, pharmacy, urinary care supplies, trach and ostomy supplies, surgical supplies, enteral feeding supplies, transportation, and extraordinary rehabilitative devices. A separate non-clinical list covers beauty and barber services, personal telephone and newspaper delivery.
That agreement also shows the billing rhythm most facilities use: room and board is billed one month in advance, and ancillary charges arrive the month after the services were provided. So your first two invoices will not look alike, and neither will match the number you were quoted.
Ownership and staffing. Staffing levels and ownership type vary widely across the roughly 15,000 federally certified facilities, and both correlate with price and with quality ratings.
Cash Price vs. Insurance: Who Actually Pays
Nursing home care is not really a cash market. It is a Medicaid market with a private-pay on-ramp.
Medicaid is the primary payer for 63% of nursing facility residents, according to KFF, against 14% for Medicare and 23% for everyone else. Medicaid also covered 44% of the $147 billion the US spent on institutional long-term care in 2023. KFF polling found four in ten Americans wrongly believe Medicare is the main payer.
Medicaid eligibility for long-term care is means-tested and unforgiving. In most states the applicant is limited to roughly $2,000 in countable assets. Federal spousal impoverishment rules, updated each January by CMS, protect the spouse who stays home: in 2026 that community spouse may keep between $32,532 and $162,660 in countable assets and a monthly income allowance between $2,705 and $4,066.50. The primary residence is generally exempt, but only up to a state home-equity limit that runs from $752,000 to $1,130,000 in 2026.
Everything above those thresholds gets spent down on care before Medicaid starts paying. Transfers made to get under the limits are subject to a look-back period, so this is a planning problem, not a paperwork problem.
Long-term care insurance pays if you bought it years earlier. Per the 2026 AALTCI Price Index, a couple both age 55 buying $165,000 in initial benefits with 3% compound growth pays about $5,010 a year combined; a single woman age 60 pays about $4,450; a couple both age 65 pays about $7,030. Pricing between carriers for identical coverage varied by up to 80% at age 65, and for a sample Illinois couple at age 60 the range ran $4,591 to $7,173, so shopping multiple carriers matters more than in almost any other insurance line.
VA benefits help wartime veterans who need help with daily activities. The 2026 Maximum Annual Pension Rate at the Aid and Attendance level is $29,093 for a veteran with no dependents (about $2,424 a month) and $34,488 with one dependent (about $2,874 a month), effective December 1, 2025. The net worth limit is $163,699, and a three-year look-back applies to asset transfers.
Private pay is what fills the gap while a Medicaid application is pending, and for many middle-income families that gap is where the savings go.
How to Pay Less
Get the ancillary charge schedule before you sign. The daily rate is the headline; the ancillary list is the bill. Ask for the written private-pay charge schedule for therapy, supplies, pharmacy and transportation, and ask which of those are billed by outside vendors who will invoice you separately. Run the all-in monthly number through our fair price checker against the state medians above.
Price the level of care you actually need, not the highest one. If the need is supervision and help with dressing rather than round-the-clock nursing, assisted living at a $6,200 national median is roughly a third cheaper. Home health care, adult day care and independent living all price below nursing home care and are frequently the right answer for a year or two first.
Start the Medicaid application before the money runs out, not after. Spend-down and look-back rules reward early planning and punish emergency filings. An elder law attorney’s fee is small next to a $115,000 annual bill.
Audit every invoice line by line. Ancillary billing errors, duplicate therapy charges and services billed after discharge are common. Our guide to reading an itemized bill works on a nursing home statement, and our negotiation guide covers how to dispute the ones that do not hold up.
Ask about charity care and nonprofit sliding scales. Many nonprofit and faith-affiliated facilities run benevolent-care funds for residents who outlive their assets. Our guide to hospital charity care explains the general mechanics of asking, and the same script works on a facility’s business office.
Do not let an unpaid balance drift. A nursing home balance is ordinary consumer debt once it leaves the facility. Our guide to medical bills in collections covers what happens next and what protections apply.
The Bottom Line
Budget $9,581 a month for a semi-private room and $10,798 for a private room as the 2026 national midpoint, then adjust hard for your state, where the semi-private median runs anywhere from $5,627 to $27,831. Add ancillary charges on top of whatever daily rate you are quoted.
Then settle the payer question early, because it is worth more than any price negotiation. Medicare pays for short skilled stays only, capped at 100 days per benefit period with $217 a day owed from day 21. Everything longer is Medicaid, insurance you bought years ago, VA benefits, or your own savings. If the situation is end-of-life rather than long-term, our guide to hospice care costs covers the one long-term care benefit that is almost fully covered.