Free guide
Who pays for care? Medicare, Medicaid, VA, and private pay
Paying for care is one of the hardest parts. This guide explains the main sources in plain words so you know which questions to ask.
Short answer
Medicare covers short-term skilled care, home health under certain conditions, and hospice, but generally not long-term help with daily living. Long-term care is usually paid by private savings, long-term care insurance, Medicaid for those who qualify under their state's rules, or VA benefits for eligible veterans and spouses.
Want this organized for you? See the Care Options Plan.
Medicare
Medicare covers doctor visits, hospital stays, and some short-term care, such as skilled nursing facility care after a qualifying hospital stay, home health care when certain conditions are met, and hospice. Medicare generally does not pay for long-term custodial care, such as help with bathing and dressing in assisted living or a nursing home over the long term.
Medicaid
Medicaid is run by each state, so names, rules, and waiting lists differ. Many states have programs that help pay for nursing home care and for care at home or in the community, often called waivers or home and community-based services. Eligibility depends on income, assets, and care needs.
The look-back
When someone applies for long-term care Medicaid, the state reviews gifts and transfers made during a look-back period before the application, generally five years. Giving away money or property during that time can delay coverage. Talk with an elder law attorney licensed in your loved one's state before transferring any assets. Thinking about selling or transferring the home? Read selling a loved one's home: Medicaid, Medicare, and money questions first.
VA benefits
Veterans and surviving spouses may qualify for help, including Aid and Attendance or Housebound benefits added to a VA pension, and caregiver support. A VA accredited representative can help you apply at no cost. Be wary of anyone who charges to file for benefits, or who sells annuities or trusts to help someone qualify. VA pension, including Aid and Attendance, reviews asset transfers made during a look-back period, generally 3 years, and transfers for less than fair value can lead to a penalty period. VA.gov explains this on its pension rates page.
Private pay and other sources
Many families pay from savings, income, long-term care insurance, or the sale of a home. A fee-only financial planner can help you plan. Ask any provider for written prices and what is included.
Can a family caregiver be paid?
Sometimes. Many state Medicaid programs let people direct their own care and hire a family member or friend, and the VA has caregiver programs for some veterans. Rules on which relatives can be paid vary by state. Ask your state Medicaid agency or your local Area Agency on Aging what is available. If a relative is paid privately, ask an elder law attorney about a written caregiver agreement before payments start, because Medicaid may treat unwritten payments as gifts.
Easy-to-miss Medicare and insurance details
- Medicare generally covers skilled nursing rehab only after an inpatient hospital stay of at least 3 days in a row. Days under observation do not count.
- Medicare Advantage plans use networks. Check that a facility or agency is in network before admission.
- Medigap is easiest to buy in a one-time 6-month window after someone is 65 or older and has Part B.
- Signing up late for Part B or Part D can mean a lasting penalty.
- Long-term care insurance usually has an elimination period before benefits start, so call the insurer early.
Where to start
- Call your loved one's local Area Agency on Aging through the Eldercare Locator.
- Contact the state Medicaid agency. USA.gov lists each one.
- For veterans, contact a VA accredited representative.
- Meet with an elder law attorney or fee-only financial planner before big decisions.
Common questions
Does Medicare pay for assisted living?
Medicare generally does not pay for room and board or long-term custodial care in assisted living. It may cover some medical services received there.
Does Medicaid pay for assisted living or a nursing home?
Medicaid can help pay for nursing home care for people who qualify, and many states have programs that help with care at home or in assisted living. Rules vary by state.
What is the Medicaid look-back?
A review of gifts and transfers made during a period before applying for long-term care Medicaid, generally five years. Transfers in that time can delay coverage. An elder law attorney can explain your state's rules.
Can I get paid to care for my loved one?
In many states, Medicaid self-directed programs allow a family caregiver to be paid, and some veterans qualify for VA caregiver support. Which relatives can be paid varies by state.
Rules vary by state. Check with your state agency or a licensed professional where your loved one lives.
Want this organized for your family? The Care Options Plan and Monthly Guidance turns it into a personalized checklist with reminders. See plans.
Official resources and further reading
- Medicare.gov: Long-term care
- Medicare.gov: Skilled nursing facility care
- Medicare.gov: Inpatient or outpatient hospital status
- Medicare.gov: When can I buy Medigap?
- Medicare.gov: Avoid late enrollment penalties
- Medicare.gov: Home health services
- Medicare.gov: Hospice care
- USA.gov: Medicaid, including how to contact your state Medicaid agency
- Medicaid.gov: Self-directed services
- Administration for Community Living: LongTermCare.gov
- VA.gov: Aid and Attendance and Housebound benefits
- VA.gov: Veterans Pension rates, net worth, and the look-back
- VA.gov: Get help from an accredited representative
- VA Caregiver Support Program
- Eldercare Locator (1-800-677-1116)
Links go to public resources. Kinhaven is not affiliated with them.