39% of middle-income Americans plan to use Medicare to pay for long-term care, even though Medicare does not cover these expenses

WASHINGTON – The latest edition of the American Council of Life Insurers’ (ACLI) Financial Resilience Index and accompanying survey reveals urgent gaps in middle-class Americans’ understanding of and plans for paying for long-term care.

The survey, conducted by YouGov, found that 39% of middle-class Americans plan to use Medicare to cover their long-term care in retirement, even though Medicare explicitly does not cover the expenses associated with long-term care. An additional 23% have not thought about how they will pay for long-term care, meaning that a significant majority of Americans are financially unprepared for health challenges as they age.

The gap in long-term care planning comes as the ACLI survey also finds that 46% of middle-class Americans over 61 are concerned about their ability to afford healthcare services over the next year, underscoring both the immediate challenge for seniors of affording care and the long-term lack of planning across all ages to pay for it.

“Nearly all Baby Boomers have reached retirement age, Americans are living longer than ever before, and the increasing cost of in-home care is significantly out-pacing inflation, which creates an intersecting set of trends that may create significant financial challenges,” said David Chavern, President & CEO of ACLI. “Long-term care is an essential part of sound retirement planning to protect retirement savings from unexpected costs. It’s critical that Americans understand their long-term care insurance options, which can help them maintain financial independence and dignity of choice by covering the costs of a nursing home, assisted living, or at-home care.”

Financial Resilience Ticks Down as Financial Challenges Take Root

In addition to the gaps in middle-class Americans’ understanding of and plans for paying for long-term care, the survey found that 46% of middle-class Americans are concerned about being able to afford daily essentials. These concerns are reflected in the Q2 Index, which fell 10 points between Q1 and Q2 2026. While the Headline Index remains at modestly positive score of +10, indicating that middle-class financial resilience is still reasonably strong relative to historical norms, the pace of improvements is slowing.

The downward movement in the Headline Index in the second quarter reflects another emerging financial challenge for middle-class households: slowing wage growth and persistent inflation. Inflation has outpaced wage growth since April, and this wage-price dynamic is a key reason for the decline in Headline Index in Q2.

The Cost Resilience Index declined two points to a score of -4, as cost pressures remain slightly higher than historical norms. Despite this big-picture view on cost pressures, higher energy prices in Q2 created acute cost pressures for middle-class households with rising gas prices pushing the ‘Essentials’ score farther into negative territory.

About the Financial Resilience Index

ACLI’s Financial Resilience Index, which is released quarterly, measures the ability of the middle-class to manage life’s challenges and plan for a stable future. The index tracks 26 different variables that represent typical cost pressures for middle-class households (like housing, gas and childcare) through the Cost Resilience Index and the financial resources that are available to meet them (like income, access to credit and retirement assets) through the Resource Resilience Index. By tracking the direction and magnitude of cost pressures and resources, the index reflects how middle-class financial resilience changes over time, and what is driving improvement or decline.

About the Financial Resilience Survey

ACLI’s Financial Resilience Survey is a nationally representative survey conducted by YouGov on behalf of ACLI, as a complement to the Financial Resilience Index. The survey explores how middle-class respondents understand their own financial resilience by asking questions about economic mobility, financial stressors, financial stability, and safety nets. The quarterly survey consists of two questions about financial resilience, one recurring question that will be asked at the same time each year and one that will vary within the larger theme of middle-class financial health, stress, and resilience. Respondents of all household income levels respond to the survey, with reporting focused on middle-class respondents – those earning $50,000-$150,000 in annual household income.

ACLI’s latest Financial Resilience Survey was conducted online within the United States by YouGov on behalf of ACLI from August 6 – 11, 2026 among 3,582 adults. The survey sample includes 1,404 respondents from middle-class households as well as 1,432 respondents from lower-income households and 341 respondents from upper-income households. The report and related materials only highlight comparisons between subgroups that are statistically significant. For complete survey methodology, including weighting variables and subgroup sample sizes, please contact ACLI.

For more information about both the index and the survey please visit: Financial Resilience Index.

About ACLI