If you don’t have a plan for long-term care, now’s the time to consider it. The price for nursing home care as well as assisted living have gone through the roof over the last decade. The hourly rate is also rising for someone who comes into the home to give care.

New York Life Insurance Co. reports that the average annual cost for nursing home care in the U.S. has risen 20 percent over the last five years, from $79,935 in 2009 to $95,706 in 2014. During the same time period, the monthly cost of a room in an assisted living facility has risen 34 percent, from an average of $3,100 to $4,139. And the average cost of home health care has bumped up to $21.86 per hour from $21 per hour.

These are averages. If you live in an east or west coast urban area, the price can be significantly higher. Listed below are the 10 most expensive places in the U.S. to get nursing home care, according to New York Life, ranked by the annual cost of a private room:

  1. Bridgeport-Stamford-Norwalk, Conn., $159,359
  2. Anchorage, Alaska, $156,950
  3. New York-Northern New Jersey-Long Island, N.Y.-N.J., $155,180
  4. Poughkeepsie-Newburgh-Middletown, N.Y., $155,180
  5. Hartford, Conn., $154,118
  6. Boston-Worcester-Lawrence, Mass., $146,372
  7. Rochester, N.Y., $141,244
  8. San Diego, Calif., $135,554
  9. Seattle-Tacoma-Bremerton, Wash., $131,750
  10. San Francisco-Oakland-San Jose, Calif., $130,283

New York Life points out that many of its long-term care clients start with home care and progress to either assisted living or a nursing home. While the costs may be manageable to begin with, they add up over the years and can wipe out the retirement planning of even an affluent couple.

Find a knowledgeable expert

While long-term care insurance has gotten pricier as the industry has pulled back over the last few years, Jesse Slome, executive director of the American Association for Long-Term Care Insurance, says shopping smartly can make a big difference. “The variants between different long-term care insurance products is greater than ever — not just in terms of price, but in terms of planning strategies. The typical consumer as well as the typical insurance salesperson just don’t have the expertise or experience to address these important differences,” he says.

He urges buyers to search for a knowledgeable salesperson — there is a referral service on the organization’s website, AALTCI.org, that’s a good place to start. Slome says a long-term care expert will understand the whole picture and may be able to help a client overcome such issues as pre-existing health problems, the desire to receive coverage outside the U.S., and high prices for singles.

The experts also are familiar with how state-federal long-term care partnership plans work in the many states that offer them. These complex plans protect a certain percentage of assets for someone who spends up a long-term care policy and faces the need to rely on Medicaid. Finding a plan that offers this option is particularly good for couples with a modest retirement nest egg.

Learn how to avoid being on the downside of the over 65 wealth gap.

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