How to Choose a Continuing Care Retirement Community: Fees, Contracts, and What to Know Before Signing

What Is a Continuing Care Retirement Community?

A continuing care retirement community (CCRC) is a single campus that offers independent living, assisted living, and skilled nursing care under one organizational umbrella. The promise is simple: move in while you're healthy, and if your needs change, you shift to a higher level of care without leaving the community.

That promise comes with a price. Most CCRCs charge a one-time entry fee (sometimes called an "entrance fee" or "community fee") plus ongoing monthly fees. In exchange, residents get guaranteed access to care as they age. According to LeadingAge, a nonprofit association of aging services providers, fewer than 2,000 CCRCs operate across the United States.

How does this differ from a standalone assisted living community or nursing home? Two ways. First, CCRCs require a significant upfront financial commitment. Second, most require a health screening at admission, because the financial model depends on residents entering while relatively independent.

One critical detail the brochure may not mention: not every CCRC offers every level of care on site. Some newer or smaller communities lack on-campus skilled nursing or memory care, instead partnering with nearby facilities. Before you visit, confirm which care levels are physically on campus, which are handled through partnerships, and whether there are wait lists for higher levels of care.

The Three Main CCRC Contract Types

Every CCRC contract falls into one of three broad categories. The type you choose determines how much you pay upfront, how predictable your future costs will be, and how much financial risk you carry.

Type A: Life Care

• Entry fee: Typically $200,000 to $1 million or more
• What you get: Monthly fees stay relatively stable even if you move to assisted living or skilled nursing. Healthcare costs are essentially prepaid.
• Best for: Families who want maximum cost predictability and can afford the higher entry fee.

Type B: Modified

• Entry fee: Typically $150,000 to $600,000
• What you get: A set number of days of higher-level care per year (often 30 to 60 days) at little or no extra cost. After that, you pay market rates.
• Best for: Families comfortable with some financial risk in exchange for a lower entry fee.
• Watch out: If a Type B contract includes 30 days of nursing care per year, confirm whether unused days roll over. Many contracts are "use it or lose it," meaning your parent could exhaust the included days during a short rehabilitation stay and then face full market rates for any additional care that year.

Type C: Fee-for-Service

• Entry fee: Typically $100,000 to $400,000
• What you get: Access to higher levels of care on campus, but you pay the full market rate when you need them. No prepaid healthcare guarantee.
• Best for: Families who want the campus lifestyle and are willing to self-insure against future care costs.

Type A offers the most predictable future costs. Type C is the cheapest door in, but it carries the greatest long-term financial exposure. Type B sits in the middle. Entry fee ranges above are national estimates from AARP's guide to CCRCs; actual figures vary sharply by region.

Regional Fee Variation

A family in rural Alabama will see very different numbers than a family on the Upper East Side. The table below shows approximate ranges based on publicly available industry data and state-level reports.

Region	Typical Entry Fee Range	Typical Monthly Fee Range
Northeast	$300,000 to $1,000,000+	$3,500 to $6,000
South	$150,000 to $500,000	$2,000 to $4,000
Midwest	$125,000 to $450,000	$1,800 to $3,800
West	$250,000 to $800,000	$3,000 to $5,500

These ranges reflect Type A and Type B contracts for a one-bedroom unit. Type C entry fees will generally fall at the lower end. Always request a community's actual fee schedule rather than relying on averages.

Understanding Entry Fees and Monthly Fees

Entry fees are the headline number, but monthly fees are the cost you'll live with for years. Monthly fees typically cover rent, meals, utilities, housekeeping, and a calendar of activities. Healthcare services beyond what your contract type includes are billed separately.

Factors that drive both fees up or down:

• Geographic region (see table above)
• Unit size and floor plan (studios vs. two-bedroom cottages)
• Amenity level (pool, on-site salon, fitness center)
• The community's own financial health (a community carrying heavy debt may charge more)

What to Ask About Fee Increases

CCRC monthly fees have historically risen an average of 3% to 5% per year, according to NIC MAP Vision data. That pace roughly tracks healthcare inflation. Flag anything above 6% as a red flag. Some contracts tie annual increases to the Consumer Price Index (CPI), which sounds reasonable until you recall that CPI spiked above 8% in 2022. Ask whether the contract includes a hard cap on annual increases, and if so, what that cap is.

Key questions for every community:

• "What is included in the monthly fee? What is not?"
• "How much have monthly fees increased in each of the past five years?"
• "Is there a cap on annual fee increases, and is it written into the contract?"

Refund Options and Exit Provisions

Entry fees are often partially refundable, but the word "refundable" can mean very different things depending on the contract.

Common Refund Models

• Declining refund (e.g., 50% over four years): The refundable portion shrinks each year. After four years, nothing comes back.
• High-percentage refund (e.g., 90% minus a 2% annual administrative fee): A larger share is returned to the estate, but the entry fee is higher to compensate.
• Non-refundable: The lowest entry fee, but the money is gone once you sign.

Some contracts refund close to 100% if the resident leaves within the first year, minus a small processing fee. That early-exit window matters.

Where the Refund Money Comes From

This is a detail many families overlook. Some communities pay refunds from their operating fund. Others pay only after the unit is resold to a new resident. If the community is in a slow real estate market or has low occupancy, a resale-dependent refund could take months or even years.

Script for your visit: "Can you walk me through exactly what happens if my mother needs to leave after two years? How much of her entry fee would be returned, and when would we receive it?"

Key Contract Clauses to Review Before Signing

A CCRC contract is one of the largest financial commitments a family will make outside of buying a home. These clauses deserve close attention.

Healthcare Guarantee

Does the contract guarantee access to nursing care regardless of future health changes? Type A contracts generally do. Type B and Type C contracts may include limits or conditions. Read the exact language.

Fee Increase Caps

Look for a maximum annual increase written into the contract. If there is no cap, your family's exposure is open-ended. A CPI-linked cap is better than nothing, but remember that CPI can spike. A fixed cap (for example, 5%) offers more certainty.

Termination by the Community

Under what conditions can the CCRC ask a resident to leave? Common triggers include nonpayment and behavioral issues. Some contracts also allow termination if the resident's care needs exceed what the community can provide, which circles back to whether skilled nursing and memory care are truly available on campus.

Financial Stability of the Provider

Request the community's most recent audited financial statements. A healthy CCRC typically has a debt-to-equity ratio below 1.5 and a cash-to-debt ratio above 1.0, according to benchmarks used by Fitch Ratings. If the community won't share financials, treat that as a serious warning sign.

Right to Cancel

Many states require a 30-day rescission ("free look") period after signing. Confirm this right in writing before you put pen to paper. Your state's department of insurance or aging services can tell you what protections apply locally.

Questions to Ask During a CCRC Tour

Print this list or save it on your phone. Ask every question at every community so you can compare answers side by side.

Financial

• "What is your current occupancy rate?"
• "How many residents have left in the past year, and why?"
• "May I see your most recent audited financial statements?"

Care

• "How do you determine when a resident needs to move from independent living to assisted living? Who makes that decision?"
• "Is skilled nursing care and memory care available on this campus, or through a partner facility?"
• "Are there wait lists for any level of care right now?"

Contract

• "Can I take a copy of the contract home to review with my attorney?"
• "Is there a 30-day rescission period?"
• "Do unused included care days in a Type B contract roll over to the next year?"

Resident Life

• "May I speak with a current resident and a family member of a resident?"
• "Can we have lunch here on an unannounced visit?"

Staff

• "What is your staff turnover rate for nursing and caregiving positions?" (High turnover often signals deeper problems.)

How to Compare CCRCs: A Side-by-Side Worksheet

After visiting two or three communities, the details blur together. A simple comparison worksheet keeps everything straight.

For each CCRC, record:

Category	Community A	Community B	Community C
Contract type (A, B, or C)
Entry fee
Refund percentage and terms
Monthly fee
Fee increase history (past 5 years)
Fee increase cap (if any)
Included services
On-campus care levels
Occupancy rate
Rescission period
Financial health (debt-to-equity)

If you've already compared standalone assisted living options, the format will feel familiar. Our 10-point worksheet for comparing assisted living contracts covers overlapping ground and pairs well with this CCRC-specific checklist.

Red Flags to Watch For

• No refund option at all, with no corresponding discount on the entry fee
• No cap on annual fee increases
• Refusal to share audited financial statements
• Pressure to sign immediately or "hold" a unit with a non-refundable deposit
• Higher-level care available only through an off-campus partner with no guaranteed bed

Next Steps and Resources

Before signing any CCRC contract, consult an elder law attorney. Legal fees for a contract review typically run $500 to $2,000, a small fraction of the entry fee at stake.

Additional steps:

• Check licensing and complaints. Contact your state's department of insurance or aging services, or start at the Eldercare Locator to find the right agency.
• Review financial disclosures. Many states require CCRCs to file annual financial reports. Ask the community for a copy or request one from your state regulator.
• Read further. AARP's guide to continuing care retirement communities and Medicare.gov's overview of long-term care options offer useful background.

This article provides general information about CCRC contracts and fees. It is not legal or financial advice. Consult a qualified elder law attorney or financial planner before making decisions about a specific community or contract.