How to pay for a nursing home or assisted living

Who this guide is for

For people who need help with daily activities for a long time, at home, in assisted living or in a nursing home, and for families planning ahead. Most long-term care is custodial care (help with bathing, dressing, eating and using the bathroom) rather than medical care.

Ways people pay

Medicare

Does not pay for long-term care, in a nursing home or in the community, when custodial care is the only care you need. It pays only for a short skilled nursing facility stay after a qualifying hospital stay, and for hospice and home health care under its own rules. See what Medicare covers.

Medicaid

Every state Medicaid program must cover nursing facility care for eligible people age 21 and older who need it, in a Medicaid-certified facility, and may not put it on a waiting list. Many states also pay for some care at home or in assisted living through home and community-based services, which can have waiting lists. You must qualify by income, savings and need, under your state’s rules.

Long-term care insurance

Private insurance you can buy that pays for some long-term care services. Policies differ in what they cover, how much and for how long they pay, and when they start paying: read the policy.

Veterans’ benefits (VA)

For veterans enrolled in VA health care who need it, VA can provide nursing home care in VA Community Living Centers, community nursing homes that work with VA, and State Veterans Homes; help with the cost depends on income and service-connected disability. VA does not run or pay for assisted living homes, though VA benefits may cover some extra services there. The Aid and Attendance benefit adds a monthly payment to a VA pension for veterans and survivors who need help with daily activities or live in a nursing home.

Paying yourself

Many people pay with their savings and income, especially for assisted living. Ask for the daily or monthly rate and every extra charge in writing.

Questions to ask when you call or visit

• Does the home accept Medicaid? If my money runs out and I switch to Medicaid, can I stay in my room?
• What does the daily or monthly rate include, what costs extra, and how often do rates go up?
• Ask your state Medicaid agency: how do I apply, what counts as income and savings, and how long does a decision take?
• Does my long-term care insurance cover this place and this level of care? Is there a waiting period before it pays?
• Veterans and survivors: ask VA whether you qualify for long-term care or Aid and Attendance.

Warning signs

• Someone tells you Medicare will pay for a long stay in a nursing home or in assisted living for custodial care. It does not.
• A contract that asks a family member to be personally responsible for payment, or pressure to sign quickly. Read every contract and ask questions before you sign.

Costs and who pays

Estate recovery: for Medicaid enrollees age 55 or older, states must seek to recover, from the person’s estate after death, what Medicaid paid for nursing facility care, home and community-based services, and related hospital and prescription drug services. States may not recover while a spouse, a child under 21, or a blind or disabled child of any age survives, and must have a way to waive recovery when it would cause undue hardship.

Married couples: Medicaid’s spousal impoverishment rules protect part of the couple’s savings and income for the spouse who still lives at home, so that spouse is not left with little or nothing.

Hospice can be given in a nursing home or in assisted living, but Medicare hospice does not pay for room and board there.

In general terms only. Deductibles, coinsurance and other amounts change every year, and Medicaid rules differ by state: check Medicare.gov, call 1-800-MEDICARE or your state Medicaid agency, and ask your plan.

How to complain or get help

• The Long-Term Care Ombudsman in your state is free and independent: ombudsmen help residents of nursing homes, assisted living and other care homes (and their families) with complaints and with residents’ rights. Find yours through the Eldercare Locator, 1-800-677-1116.
• Medicaid decisions: if your state denies or ends your Medicaid, ask the state Medicaid agency how to appeal (ask for a fair hearing).
• If you think someone is being abused, neglected or exploited and is in danger, call 911. You can also report it to the state agency and to Adult Protective Services (the Eldercare Locator can give you the number).
• Medicare: 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, free, with help in Spanish and other languages.

Find care on US Patient Guide

Common questions

Sources

• Long-term care: what Medicare covers (Medicare.gov)
• Nursing facilities (Medicaid.gov)
• Long-term services and supports (Medicaid.gov)
• Estate recovery (Medicaid.gov)
• Spousal impoverishment (Medicaid.gov)
• Long-term care (U.S. Department of Veterans Affairs)
• VA Aid and Attendance benefits and Housebound allowance (U.S. Department of Veterans Affairs)
• Long-term care: planning and paying (U.S. Administration for Community Living)
• Long-Term Care Ombudsman Program (U.S. Administration for Community Living)
• Eldercare Locator (U.S. Administration for Community Living), 1-800-677-1116

Written in plain language by US Patient Guide from the official sources above, November 11, 2026. The facts on each provider page come from the official data shown on that page, with its date. Not medical advice.