Dave Ramsey wants 'virtually everyone' covered for long-term care by 60, or they may end up depending on the government

Those costs can eat away at your nest egg. And, if you’re married, you’ll need enough for your spouse to continue living at home and paying the bills.

“And that’s why I advise virtually everyone to put good, long-term care coverage in place at age 59 or 60,” personal finance expert Dave Ramsey told KTAR News. “It can mean the difference between living with dignity, or having to depend on the government.”

LTC insurance isn’t cheap, so you may be wondering if you really need it. Or, if you plan to get it, when is the right time? Here’s what you need to know.

Why Medicare alone won’t cut it

Americans turning 65 have an almost 70% chance of needing LTC supports in their remaining years, though the duration and level of that support can change over that time. One in five (20%) will need LTC support for more than five years.

Yet, only 3% of U.S. adults — and 15% of those aged 65+ — have LTC insurance, according to a survey of Americans with $100,000 or more in investable assets by the Center for Retirement Research (CRR) of Boston College.

Perhaps a bigger issue highlighted by the survey is that “people had little idea of the likelihood of needing long-term care or of the potential costs of that care,” writes Alicia H. Munnell, a senior advisor with CRR.

While Medicare covers short-term nursing care for acute medical needs, it doesn’t cover long-term care. And, while Medicaid does cover LTC, it comes with significant trade-offs.

Many older Americans believe they can “fall back on Medicaid,” writes Munnell, not realizing “the program’s income and asset limits require impoverishment.”

Medicaid is jointly funded by the federal and state governments, but is managed at the state level. To qualify, you’ll need to meet specific income and asset limits, including limits on home equity. If your income is slightly above that limit, some states allow you to “spend down” your excess income on medical costs to meet that threshold.

Even if you do qualify for Medicaid, you still have to pay for part of it.

Once eligible for Medicaid, enrollees who use long-term care must generally contribute nearly all monthly income to the cost of their care except for a small ‘personal needs allowance,’” according to KFF. In 2026, that allowance is $70 for institutional care and $2,982 for home care.

For those who don’t qualify for Medicaid, you may end up tapping into your home equity — though this wasn’t a popular option among the CRR survey respondents.

While only a third of respondents said they’d consider this option, the cumulative likelihood of tapping into your home equity increases with age. More than 40% will end up getting a second mortgage, applying for a home equity line of credit (HELOC) or downsizing.

Another unpopular option was moving in with your adult children, yet about a quarter of older Americans end up doing so, according to the survey.

Should you get LTC insurance?

LTC insurance is, like the name suggests, an insurance product that you buy through an insurance company and brokerage. It can help to cover the cost of a nursing home or assisted living facility, as well as in-home care, adult day care services and even home modifications to age in place.

The cost of LTC insurance varies depending on factors such as your age, health and family health history, as well as the type of policy you choose. For example, you can choose inflation protection riders as part of your policy, but you’ll pay more.

As an example, a 60-year-old woman purchasing $165,000 in benefits will pay an average annual premium of $4,450, according to the 2026 AALTCI Long-Term Care Insurance Price Index. A couple, both aged 65, each purchasing $165,000 in benefits with a 3% compound growth option for inflation protection will pay a combined $7,030.

So, it’s not cheap. However, some premiums may be tax-deductible, depending on your plan, your age, how much you pay and where you live. You can ask your insurance agent if your plan qualifies.

Some life insurance policies and annuities also offer an LTC rider.