Assisted living community costs in North Dakota
Here is the middle of the price range in North Dakota, and then — because it is the question that actually follows — who pays for it. The short answer on that second one surprises most people: Medicare does not.
The North Dakota median
$4,729 a month
- Works out to, monthly
- $4,729
- Works out to, yearly
- $56,748
That is about 24% lower than the national median of $6,200 a month. Within North Dakota the spread is usually wider still: a city costs more than a rural county, often by a great deal.
A licensed residential community where you rent a private one-bedroom unit and staff help with daily activities; called a residential care facility in California.
What this number is, and what it is not.
It comes from an industry cost-of-care survey — providers reporting their prices — not from a government rate table. There is no federal agency that publishes what assisted living costs, which is why the survey is the source of record here and why we label it plainly rather than dressing it up as official.
A median means half charged more and half charged less. It is not a quote for any particular home, agency or facility, and no provider is bound by it. Prices collected for the 2025 survey.
Where North Dakota sits
$4,729 a month ranks North Dakota 47th of the 50 states priced for assisted living community: 46 charge more, 3 charge less.
South Dakota is the next state up, at $4,900; Arkansas the next down, at $4,637.
The national median is $6,200, so North Dakota runs $1,471 below it — 24% less, or $17,652 a year ($1,471 × 12 months).
The column runs $4,369 (Mississippi) to $12,096 (Hawaii). North Dakota sits 5% up it, 1.08× the lowest, with 6 other within a tenth of it.
Of the 6 kinds of care North Dakota was priced for, this is its 6th dearest standing: at best 2nd of 45 for adult day health care, at worst 47th of 50 for assisted living community.
What $4,729 a month becomes
Our multiplication, holding the North Dakota median flat — no real bill does — with the same span of the state's least costly priced care beside it:
Six months
$28,374
$33,150 of adult day health care
One year
$56,748
$66,300 of adult day health care
Two years
$113,496
$132,600 of adult day health care
Three years
$170,244
$198,900 of adult day health care
Five years
$283,740
$331,500 of adult day health care
Care is bought in years, not months, and $4,729 a month is $56,748 a year.
Five years at the national median would be $372,000: $88,260 more than five years in North Dakota.
Inside North Dakota, five years of adult day health care runs $331,500 and five of skilled nursing at home (private duty nurse) $972,400; this page's $283,740 sits 0% between them. Most families pay for more than one of these in sequence.
Against other care in North Dakota
Converted to a month on our schedule, set beside this page's $4,729:
Skilled nursing at home (private duty nurse)
$16,207 a month
$11,478 a month more, $137,732 a year, 3.43× this page. North Dakota places 29th of 46 for it, 18 above its 47th here.
Nursing home, private room
$12,304 a month
$7,575 a month more, $90,900 a year, 2.60× this page. North Dakota places 20th of 49 for it, 27 above its 47th here.
Nursing home, semi-private room
$11,528 a month
$6,799 a month more, $81,588 a year, 2.44× this page. North Dakota places 19th of 50 for it, 28 above its 47th here.
In-home care (non-medical caregiver)
$6,483 a month
$1,754 a month more, $21,044 a year, 1.37× this page. North Dakota places 32nd of 50 for it, 15 above its 47th here.
Adult day health care
$5,525 a month
$796 a month more, $9,552 a year, 1.17× this page. North Dakota places 2nd of 45 for it, 45 above its 47th here.
On the same monthly footing, assisted living community is the 6th costliest of the 6 kinds of care priced in North Dakota, at $4,729. The conversions are ours; the medians are the survey's.
44 hours a week of in-home care in North Dakota is $6,483 a month against $4,729 for assisted living — 27% less. The first buys 44 hours and nothing else; the second includes the room, the meals, and someone awake overnight.
Who actually pays for this
This is the part most cost pages leave out, and it is the part that changes what a family does next.
Medicare does not pay for long-term care
Medicare pays for short stretches of skilled care — a limited stay in a skilled nursing facility after a qualifying hospital admission, or skilled home health under specific conditions. It does not pay for custodial care: help with bathing, dressing, meals, medication reminders and supervision. That is what most people need, and for years at a time.
Medicare's own page on long-term care ↗ says the same thing in its own words. It is worth reading once, because almost everyone assumes the opposite.
Medicaid may pay — after a spend-down
Medicaid is the largest payer of long-term care in the country, but it is needs-based: it begins once income and countable savings are inside the limits North Dakota sets. Getting there by spending savings on care is what people mean by a spend-down. There is also a look-back period, so gifts and transfers made in the years beforehand matter.
Veterans: Aid and Attendance may help
A wartime veteran, or a surviving spouse, who needs help with daily activities may qualify for an addition to the VA pension called Aid and Attendance. It is an income-and-net-worth benefit, it is paid monthly, and a great many families who qualify have never heard of it. Accredited veterans service organizations help with the claim for free.
Otherwise: savings, family, and long-term care insurance
Most families pay out of pocket first — from savings, a pension, the sale of a house, or several relatives contributing. A long-term care insurance policy bought years ago pays a daily or monthly amount if the policy's conditions are met; if there is a policy in the family, find it and read what triggers it before you need it.
Working out which of these applies to one particular family is exactly what a free North Dakota counselor does all day. They are paid by a federal grant, not by commission, and they have nothing to sell you. The Eldercare Locator (ACL): 1-800-677-1116 ↗ will connect you to the area agency on aging for your county.
Who to ask in North Dakota
North Dakota's free counseling program is State Health Insurance Counseling Program (SHIC), on 1-888-575-6611. It is grant-funded and sells nothing.
North Dakota Health and Human Services decides Medicaid long-term care here — not a facility, and not us. North Dakota runs it as Nursing facility (institutional) Medicaid and Regular Medicaid for the aged, blind and disabled, with a 60-month look-back on gifts and transfers.
Beside $4,729 a month — our comparison, its limits — that is what "spend-down" means: countable assets may not top $3,000, or about 19 days of assisted living community at this rate.
Verified 2026-08-02 against CareScout (formerly Genworth) Cost of Care Survey 2025, fielded July-November 2025 (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Verified 2026-08-02 against SHIP National Technical Assistance Center (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Verified 2026-08-02 against North Dakota Health and Human Services, Medicaid Billing and Policy Manual — Nursing Facilities (updated April 2026), with the Department's Medicaid eligibility pages (effective 2026-01-01)
Common questions
- Does Medicare pay for assisted living community in North Dakota?
- No. Medicare pays for short stretches of skilled care after a qualifying hospital stay, and for skilled home health in limited circumstances. It does not pay for long-term custodial care — help with bathing, dressing, meals and supervision — which is what most families are actually paying for.
- Is assisted living community dearer in North Dakota than in other states?
- $4,729 a month places North Dakota 47th of the 50 states the survey priced for it: 46 charge more and 3 charge less. The national median is $6,200. That ranking is our arithmetic on the survey's published medians, not a ranking the survey itself publishes.
- Is this the price I will be quoted in North Dakota?
- No. It is the middle of a range from an industry cost-of-care survey: half of the providers surveyed charged more, half charged less. Prices vary a great deal between a city and a rural county in the same state, and no facility is bound by this figure.
- Who can help me work out how to pay for it?
- North Dakota runs its free counseling program as State Health Insurance Counseling Program (SHIC), on 1-888-575-6611. It is paid for by a federal grant, sells nothing, and the Eldercare Locator (1-800-677-1116) will connect you to the area agency on aging that covers your county.