Continuing care retirement community cost in DC, Maryland and Virginia: what entrance fees buy, how refunds work, and who checks the provider's books.
By DC Senior Advisor Care Team · October 21, 2026
The first quote a family gets from a life plan community in Friendship Heights, downtown Bethesda or the Rosslyn-Ballston corridor tends to read less like a care bill and more like a real estate closing statement. That is the thing to understand before anything else: continuing care retirement community cost in DC, Maryland and Virginia is always two numbers, not one. There is an entrance fee paid up front, and there is a monthly service fee paid for as long as your parent lives there. In this metro, where land is expensive and the buildings compete with Chevy Chase and McLean condo prices, entrance fees commonly land somewhere between roughly $150,000 and $600,000 or more depending on the unit, the contract and the refund option attached to it, while monthly service fees for an independent living apartment commonly run in the $3,000 to $7,000 range. Neither number is the whole story, and a community quoting a low entrance fee is often quoting a higher monthly fee, a thinner care guarantee, or both.
That two-number structure is also what makes a CCRC different in kind from the assisted living communities most DC-metro families tour first. A standalone assisted living residence charges a monthly rate — generally $5,500 to $8,500 across this metro in 2026, with memory care at $7,500 to $11,000 and a private nursing room at $10,000 to $14,000 — and you pay it month to month. A continuing care retirement community asks for a large payment at the front end in exchange for a promise about the future: that when your parent needs more help, it will be available on the same campus, often at a price that is partly locked in. Whether that promise is worth the entrance fee depends almost entirely on which of three contract types you are signing, which is where most families stop reading and should not.
Continuing care contracts come in three recognized flavors, and the industry labels are worth memorizing because the brochures rarely lead with them. A Type A, or extensive, contract is the closest thing to prepaid care: a large entrance fee and a monthly fee that stays roughly level even after your parent moves from an independent apartment into assisted living or the nursing unit. You are buying insurance against the $10,000-to-$14,000-a-month skilled nursing bill, and you pay for that insurance in the entrance fee. A Type B, or modified, contract covers a defined amount of higher-level care — a set number of days, or care at a discounted rate — after which the monthly fee rises toward market rates. A Type C, or fee-for-service, contract offers priority access to the campus's assisted living and nursing beds but charges market rate when your parent uses them, which means the entrance fee buys location and a place in line, not price protection.
There is also a fourth model that has grown quickly across Northern Virginia and Montgomery County: the rental or month-to-month community with no entrance fee at all. These are genuinely a reasonable fit for some families, particularly when a parent is already at the point of needing assisted living rather than moving in healthy at 78, since a Type A entrance fee only pays off over a long runway. The question to ask yourself honestly is how many years of independent living your parent is likely to have before care needs start. A Type A contract signed at 80 with meaningful care needs already present is usually the worst value of the four options, and a good admissions director will say so if asked directly.
Most DC-area communities offer the same unit under two or three different refund structures, and the spread between them is the single largest swing in continuing care retirement community cost. A declining-balance or amortizing refund is the common default: the refundable portion shrinks by some percentage each month of residency — often one to two percent — until it reaches zero after four or five years. A 50 percent or 90 percent refundable option keeps a fixed share of the entrance fee available to your parent's estate no matter how long they live there, and costs substantially more up front, sometimes 30 to 60 percent more for the same apartment. Families who view the entrance fee as part of an inheritance plan gravitate toward the refundable options; families who view it as the price of care and want the lowest cash outlay take the amortizing one.
Read the trigger and the timing language with real attention, because that is where refunds quietly die. Many contracts pay the refund only after the apartment is re-occupied by a new resident, which in a soft quarter can mean many months of waiting. Others deduct a non-refundable administrative or renovation fee, prorate the period between notice and move-out, or treat a move to the campus nursing unit differently from a move off campus entirely. Ask for the actual refund paid on the last several departures rather than the policy as written, ask how long each one took, and have an elder law attorney licensed in the District, Maryland or Virginia read the agreement before any deposit is made. This is a contract most families sign exactly once, and the deposit is often the largest check of a parent's retirement.
An entrance fee is an unsecured bet on the operator still being solvent in a decade, so it matters that the three jurisdictions in this metro supervise that promise differently. In Virginia, continuing care providers register with the State Corporation Commission's Bureau of Insurance under the continuing care provisions of the Virginia Code, which is why a community in Arlington, Alexandria, Fairfax or Reston can hand you a disclosure statement with audited financials and actuarial information in it. In Maryland, continuing care retirement communities register with the Maryland Department of Aging, and communities in Bethesda, Rockville, Silver Spring, Wheaton or Hyattsville can likewise produce a current disclosure statement on request. Ask for the most recent one in either state, and ask specifically about occupancy rates, debt service and whether the community funds a reserve for future care obligations.
The District does not operate a continuing-care financial registration office that parallels those two, so for a community inside DC the audited financial statements come from the provider itself and deserve more scrutiny, not less. What DC Health's Health Regulation and Licensing Administration (HRLA) does regulate is the care — an Assisted Living Residence inside a DC campus is licensed under the Assisted Living Residence Regulatory Act of 2000 like any other. In every case, treat the financial review and the care review as two separate jobs. A beautifully run care operation inside a financially strained nonprofit is still a risk to an entrance fee, and a rock-solid balance sheet says nothing at all about staffing on the memory care floor.
Families touring a campus often assume that because everything sits under one roof and one brand, the care levels have been vetted as a package. They have not. Each level is licensed separately by the same agencies that license freestanding providers, and the inspection records live in the same public files. In the District, the assisted living component is licensed by DC Health's HRLA. In Montgomery and Prince George's counties, the assisted living program is licensed by the Maryland Department of Health's Office of Health Care Quality (OHCQ) under COMAR 10.07.14 at Level 1, 2 or 3, and the nursing component is licensed as a comprehensive care facility — ask which Level the campus actually holds, because a Level 2 program cannot keep a resident whose needs have moved past it. In Northern Virginia, assisted living is licensed by the Virginia Department of Social Services (VDSS) under 22VAC40-73 and the nursing facility by the Virginia Department of Health (VDH).
So pull the inspection history for each level on the campus before signing, not just the one your parent is moving into, since the whole premise of the contract is that they will use the others. Then ask the question that exposes a hollow continuum: when was the last time the campus could not accommodate a resident internally and had to transfer them out to another provider? Communities with genuinely sufficient capacity answer that quickly. If your parent may eventually rely on Medicaid, know that none of these programs pay entrance fees — DC Medicaid through the Department of Health Care Finance offers the Elderly and Persons with Physical Disabilities (EPD) Waiver, Maryland Medical Assistance offers the Community Options Waiver and Community First Choice, and Virginia Medicaid under the Cardinal Care umbrella at DMAS covers long-term services, with the Auxiliary Grant helping low-income residents of licensed Virginia assisted living. For free, unbiased help sorting options, DC families can call the Department of Aging and Community Living at (202) 724-5626, Maryland families can call Maryland Access Point at 1-844-MAP-LINK or Montgomery County Aging and Disability Services at (240) 777-3000, and Virginia families can reach the Arlington Area Agency on Aging, the Alexandria Division of Aging and Adult Services or the Fairfax Area Agency on Aging.
Free, no pressure, and no one rushing you. We answer to families, not to facilities.
Or call (571) 497-4418
DC Senior Advisor