Assisted Living Cost by State (2026 Genworth Data)

The national median for assisted living hit $74,400 a year in the 2025 Cost of Care Survey from Genworth Financial and CareScout, published March 2026. That figure hides a 3.3x spread: a private one-bedroom unit runs $52,425 annually in Mississippi and $145,155 in Hawaii. Same care category, same survey, $92,730 apart.

For households planning around a parent’s care—or their own—the national number is close to useless. Geography drives the bill more than facility quality, amenity tier, or acuity level. What follows is the full state-by-state breakdown, the daily-rate math most coverage skips, and where the $150k+ planning thresholds actually sit.

The national numbers at a glance

Genworth restructured its 2025 reporting, folding homemaker and home health aide rates into a single “non-medical caregiver” category after two-thirds of agencies began charging identical rates for both. Assisted living reporting stayed consistent: a private, one-bedroom unit, monthly base rate as reported by surveyed communities.

Source: Genworth Financial and CareScout, 2025 Cost of Care Survey, released March 2026.

The 5% annual jump sits above general inflation but well below the 10% spike assisted living posted in 2024. Elder care cost benchmarks for affluent families show this category running hotter than skilled nursing on a percentage basis over the past three years—occupancy recovered from 77% to 84% across the survey period, and tight supply keeps pricing power with operators.

State-by-state median costs

Ranked by monthly median, the geography splits into recognizable tiers. The Northeast corridor and Hawaii anchor the expensive end; the Deep South and parts of the Mountain West sit cheapest. The table below covers all states with reported data, monthly and annual.

Source: Genworth Financial and CareScout, 2025 Cost of Care Survey median cost data tables, released March 2026. California reported as “residential care facility.” Alaska assisted living reported per survey; nursing-home figures statewide run far higher.

Seven states cross six figures annually. Hawaii, Massachusetts, Connecticut, New Jersey, Vermont, Maine, and Alaska all price a base unit above $98,000 a year before a single care-level surcharge. The cluster is not random—high cost of living, constrained land, and wage pressure on caregivers compound in those markets. Regional elder care cost differences track closely with general housing costs, which is why a Northeast-to-Midwest relocation can cut the bill nearly in half.

The Finluxy Care Cost Daily Rate

Monthly and annual figures obscure the unit that actually matters when comparing care types: cost per day. The Finluxy Care Cost Daily Rate expresses the all-in daily cost for the care level analyzed, inclusive of facility fee, ancillary services, and medication management. For base assisted living, Genworth’s reported daily rate is the starting point; affluent-market communities layer ancillaries on top.

Base daily rate: Genworth and CareScout 2025 Cost of Care Survey. Finluxy Care Cost Daily Rate adds a $600/month ancillary and medication-management estimate ($20/day) to the reported base, per Finluxy methodology; actual ancillary charges vary by community and acuity.

The ancillary layer is where affluent households get surprised. The base monthly service fee covers room, meals, and basic personal care. Medication management, escalating care-level tiers, and à la carte services push the real Finluxy Care Cost Daily Rate 10% to 40% above the published median. A community advertising the state median rate can bill 50% higher within a year as a resident’s needs climb—a pattern detailed in the memory care versus assisted living cost comparison, where acuity surcharges compound fastest.

What the published median leaves out

Most coverage stops at the monthly figure. The number that predicts a household’s actual spend is the gap between the base rate and the loaded rate after care-level surcharges—and that gap widens precisely as a resident ages in place.

Here is what the dataset shows that the headlines miss: the states with the highest base assisted living costs are not always the states with the steepest total elder-care burden. Texas posts a below-median assisted living rate of $5,666 a month but one of the lowest nursing-home semi-private rates in the country at $5,627 a month—rare among states, the two settings cost nearly the same. In most states assisted living runs roughly 60% of nursing-home cost, so the assisted living “discount” carries a hidden penalty: when acuity forces a move to skilled care, the monthly jump is far larger elsewhere. A family optimizing only on assisted living’s sticker price may be choosing a state where the next rung up the care ladder is brutal. Nursing home cost for a private room averages $129,575 nationally—a step that reframes which “cheap” states are actually cheap across a full care trajectory.

Methodology

What Medicare and Medicaid actually pay

Zero. Original Medicare pays nothing toward assisted living room, board, or custodial care, because those services are not medically necessary under program rules. CMS treats assistance with bathing, dressing, eating, and supervision as custodial—outside Medicare’s medical mandate. Medicare Advantage and Medigap follow the same rule; none cover the monthly service fee.

What Medicare does cover continues unchanged inside an assisted living community: physician visits, hospital stays, approved prescriptions under Part D, and durable medical equipment. After a qualifying hospital stay, Part A covers a skilled nursing facility (SNF) stay—fully for the first 20 days, then with a $209.50 daily coinsurance for days 21 through 100 in 2025, after which the resident pays everything. That is skilled care, not assisted living, and the distinction trips up families expecting a seamless handoff. The Medicare versus private pay gap in elder care is the single largest budgeting blind spot for new caregivers.

Medicaid waiver programs in many states cover personal-care and support services within assisted living—but never room and board, and only for those who meet strict asset and income limits. For $150k+ households, Medicaid is generally irrelevant as a funding source without deliberate, years-ahead planning that most affluent families neither want nor pursue.

The $150k+ planning frame

At $150k+ in household income, the relevant question is not whether you can afford assisted living—it is how long, and whether to insure against the tail. A national-median unit at $74,400 a year consumes roughly half of a $150k pre-tax income; a Hawaii or Massachusetts unit consumes nearly all of it. For a couple where one spouse needs care while the other maintains a household, the math turns hostile fast.

Three thresholds matter for this income band. First, duration: the national median assisted living stay runs two to three years, but dementia trajectories extend far longer, and a five-year stay at a high-cost-state median crosses $500,000 in base fees alone. Second, the self-funding line: households with $1.5 million-plus in liquid assets outside their primary residence can generally self-insure a typical stay without an LTC policy, while those between $500,000 and $1.5 million face the hardest call. The long-term care insurance break-even analysis models exactly where premiums beat self-funding, and the answer hinges on claim probability and care duration more than on premium size. Third, location flexibility: a household willing to relocate a parent from a six-figure state to a $60,000 state recovers more through geography than almost any other lever, though it trades dollars against proximity.

The defensible move is to model your own state’s loaded Finluxy Care Cost Daily Rate—base plus realistic ancillaries—across a three- and five-year horizon, then stress-test it against a forced step-up to skilled nursing. Households that build a parent care savings target around the loaded rate rather than the advertised median rarely get blindsided; those who anchor on the headline number routinely underfund by a third. A fee-only advisor who models long-term care as a discrete liability—rather than folding it into a generic retirement projection—earns their cost here, because the geographic and acuity variables make this one of the few expenses where the national average misleads more than it informs.