The care years
A household paying for qualified long-term care out of pocket. Change anything; the comparison re-runs instantly.
Who should pay for the bad years?
The same cash need — normal spending plus care — funded three ways. Qualified care costs are deductible medical expenses above 7.5% of AGI, and a deduction that size changes which account should write the checks.
How the math works
The mechanism
Qualified long-term care — nursing-home care, and home care for someone certified chronically ill — is a deductible medical expense to the extent it exceeds 7.5% of AGI. A $120,000 care year is a six-figure deduction. Ordinary income up to that deduction is effectively tax-free — which means traditional IRA withdrawals, normally the most expensive dollars you own, can come out at close to 0% while the care lasts. The tool solves tax, the taxable share of Social Security, and the withdrawal size together, since the deduction itself depends on the AGI the withdrawal creates.
What the comparison means
Funding the care years from the Roth sets the tax floor — but it spends the one asset whose growth is tax-free forever, precisely when the IRA is on sale. The effective rate shown for the traditional strategy is measured against that Roth floor: it's the true toll for using IRA dollars. Compare it to what the same withdrawal costs in a normal year, and the planning implication states itself: hold traditional money back for the bad years, and spare the Roth for them. This is the mirror image of the usual advice, and it only appears when someone models the deduction.
What this tool is not
A steady-state snapshot in today's dollars — one representative care year, multiplied out, not a full simulation (pair it with the Widow's Penalty tool for what often follows). Not modeled: the medical costs of the healthy spouse, other itemized deductions stacking with the medical one, LTC insurance benefits or premium deductions (age-capped), Medicaid and its spend-down rules, state taxes, IRMAA (a large gross withdrawal can spike Medicare premiums two years later even when income tax is zero — check the Marginal Rate Explorer's MAGI readout), balance limits (the tool assumes the accounts can cover the withdrawals), and the certification rules that make care "qualified." Deduction rules current as of 2026 law.