By Steve Dinnen In a developed nation you have a 90% chance of living to age 65. After that age, you have a 70% chance of needing some sort of long-term health care. And if that happens, you have a 100% chance of being shocked, surprised and dismayed at how much it will cost you. The average cost of nursing home care in Des Moines is $379 per day. The average stay is 485 days, which means on average you will shell out $183,815. That’s a fair amount of money to come out of your bank account. And no, Medicare will not help much. A majority of Americans believe that Medicare will pay for “long-term care,” a catch all for nursing homes, in-home health care and memory care. They are, sadly, mistaken. It covers only 21 days of care post hospital stay — for instance, rehabilitation after a surgical procedure.  “Medicare does very little to help,” said Matt Richman, a retirement strategist at Iron Point Retirement Solutions in West Des Moines. Aside from just paying out of pocket, some relief can come by way of a long-term care insurance. Richman said some better assistance might come your way with either an annuity, designed specifically with long-term care expenses in mind, or a life insurance policy that likewise factors in the demands of health care later in life. Some life insurance policies have a living benefit provision in them, which allows a policyholder to tap benefits that normally would arise only upon your demise to instead pay for nursing home care. If you never need it, the entire benefit stated in the policy will pass to your heirs. A long-term care annuity, sometimes referred to as an LTC annuity, is a hybrid financial product that combines retirement savings with coverage for care costs. It allows you to pay for care, and if unused, the balance passes to beneficiaries. Key benefits here include tax-deferred growth, and, often a cash indemnity model that pays 100% of the monthly benefit without requiring receipts for care. Richman said he would recommend an annuity over a life insurance product for people over 65, since the latter doesn’t require health underwriting. Any way you look at it, long-term care will cost you money. But making a plan and weighing your options in advance can help you make the smart financial choice for yourself. Assisted-living costs vary widely by city and state If assisted living is your destiny, and you’re pinching pennies (or $100 bills), you might want to take a look at Cape Girardeau, Missouri, where the average annual buy-in is $52,000. Bismarck, North Dakota, on the other hand, screams “stay away” with an average annual cost of $296,500. Nursing home costs are all over the board, and it’s not necessarily big city versus small town at play. Land and building costs, as well as staffing expenses, are big drivers on the price of nursing home stays. The Center for Retirement Research at Boston College says competition also plays a huge role. There may not be many providers in Santa Rosa, California, where a year in a single room will set you back $365,000, compared to just down the road in notably expensive San Francisco, which charges $250,000. Housing prices reverse, with San Francisco costing 74% more than Santa Rosa. The average annual expense of a private room in a nursing home in Des Moines is $138,335. A shared room, which most insurers will recommend, costs $119,173, per figures compiled by the American Council on Aging. Des Moines was the most expensive city in Iowa, followed by Cedar Rapids, at $136,000. Davenport was the least expensive on the list, at $106,000. ...read more read less