🧭 Overview
Long-term care is one of the most significant financial risks facing North Dakota residents, and one of the least planned for. This page brings together the numbers that matter: what care actually costs in North Dakota, how many people are currently protected by long-term care insurance (LTCI), what the state offers in tax incentives, and what Medicaid will and won't cover.
💰 The Cost of Long-Term Care in North Dakota
These figures track real rates paid by families in North Dakota last year.
| Care Setting | Annual Cost | Monthly Cost | National Rank |
|---|---|---|---|
| In-Home Non-Medical Caregiver | $77,792 | $6,483 | #32 of 50 |
| Assisted Living Facility | $56,745 | $4,729 | #47 of 50 |
| Nursing Home: Private Room | $147,642 | $12,304 | #20 of 50 |
Source: CareScout Cost of Care Survey
North Dakota ranks #32 out of 50 states for in-home care costs, near the national median for in-home care costs. For a couple in their mid-60s planning for the future, a two-to-three year care event could easily consume $251,825 or more, funds that would otherwise go to a surviving spouse, children, or retirement income.
📊 How Long-Term Care Insurance is Used in North Dakota
North Dakota has 30,615 residents currently covered by long-term care insurance policies, relatively low compared to the national average. Most recently, LTCI paid out $89,105,160 to 584 North Dakota claimants, with an average payout of $152,577 per claimant.
💸 North Dakota State Tax Incentives for LTCI Premiums
North Dakota offers a state income tax incentive for qualifying LTCI premiums. Details below.
Benefit type: Credit & Deduction
CREDIT: Tax credit equal to premiums paid, not to exceed $250 per insured individual per year, for residents who paid premiums on a qualified long-term care partnership plan. DEDUCTION: Permits the same tax deduction as is allowed for federal income tax purposes.
Statutory reference: N.D. Cent. Code §§57-38-29.3, 57-38-30.3(2), 57-38-30.3(7)(I)
Source: AHIP
🤝 North Dakota LTC Partnership Program
North Dakota participates in the Long-Term Care Partnership Program, a joint federal-state initiative that lets policyholders protect assets equal to the benefits paid out by a qualifying LTCI policy before Medicaid applies a spend-down. In practical terms, a policy that pays $300,000 in benefits allows you to protect an additional $300,000 in assets while still qualifying for Medicaid coverage. This makes partnership-certified policies especially powerful for middle-income families in North Dakota who want Medicaid as a backstop without spending down to near-zero.
🏥 Medicaid and Long-Term Care in North Dakota
Medicaid is the payer of last resort for long-term care, but qualifying requires spending down most of your assets first. Here are North Dakota's current Medicaid thresholds:
| Threshold | Amount |
|---|---|
| Medicaid Spend-Down (individual asset limit) | $3,000 |
| Community Spouse: Minimum Asset Allowance | $32,532 |
| Community Spouse: Maximum Asset Allowance | $162,660 |
| Minimum Monthly Income Allowance (spouse) | $2,643 |
In North Dakota, an individual must spend down assets to $3,000 before qualifying for Medicaid long-term care coverage. A community spouse may retain between $32,532 and $162,660. Because North Dakota participates in the LTC Partnership Program, a qualifying policy can effectively raise the protected asset amount by the total benefits paid, a significant planning advantage for couples with moderate assets.
🏠 For North Dakota Residents: Is LTCI Right for You?
Long-term care insurance isn't right for everyone, but for most middle- and upper-middle-income families in North Dakota, it is the most efficient way to protect assets, preserve choices, and avoid placing a financial burden on family members. At current North Dakota care costs, even a modest policy with a $150–$200/day benefit and a three-year benefit period could offset hundreds of thousands of dollars in out-of-pocket exposure.
Most people apply in their 50s or 60s, when they're more likely to qualify in good health and lock in lower premiums.
💼 For Financial Advisors and CPAs in North Dakota
Long-term care planning intersects directly with retirement income planning, estate planning, and tax strategy, three areas your clients rely on you to coordinate. The data on this page (care costs, LTCI claims history, tax incentives, Medicaid thresholds) gives you and your clients a factual foundation for the conversation.
If you work with clients in North Dakota and want help with quotes, a quick health pre-screen, or a partner for long-term care planning, connect with Jesse.
This page is updated annually. Data reflects the most recent available surveys as of 2025–2026. For current personalized quotes or benefit design questions, contact us.