The big picture: short-term vs. long-term
The most important distinction is between a short-term rehab stay (weeks, after a hospital visit, with therapy, aiming to go home) and a long-term stay (months or years, because living at home no longer works). Different programs pay for each.
Medicare: short-term rehab, not long-term living
Medicare is the federal health insurance most people 65+ have. It covers skilled nursing care after a qualifying hospital stay — typically up to 100 days per benefit period. In the traditional program, the first 20 days are generally covered in full, and days 21–100 carry a daily copay. Coverage continues only while the person needs skilled care (nursing or therapy), not just help with daily living.
Medicare Advantage plans (the private version of Medicare) cover the same kind of stay, but often with their own networks, prior-authorization steps, and cost-sharing. If your loved one has an Advantage plan, call the plan early — ideally before choosing a facility — and ask which local nursing homes are in network.
Medicaid: the main payer for long-term care
Medicaid — a joint federal and state program for people with limited income and assets — is how most long-term nursing home care in America actually gets paid. Rules differ by state, but the shape is the same:
- Eligibility looks at both income and assets, with limits set by your state. A home and car are often treated differently from savings.
- There are protections for a spouse who still lives at home — the rules do not require leaving them with nothing.
- States review financial transfers from the past several years (commonly five) — giving away assets shortly before applying can delay eligibility.
- Many people start as private-pay residents and transition to Medicaid when savings run down. Ask any facility you’re considering whether it accepts Medicaid and how that transition works there.
Medicaid planning has real legal consequences. For anything beyond the basics — spousal protections, asset transfers, estate questions — a certified elder-law attorney in your state is worth the consultation fee.
Paying privately, and other sources
- Private pay — paying the facility’s rate directly. Ask for the daily rate in writing, what it includes, and what costs extra (therapy, supplies, salon, phone).
- Long-term care insurance — if a policy exists, find it now. Look for the daily benefit amount, the elimination (waiting) period, and the maximum benefit; start the claim before admission if you can.
- Veterans’ benefits — wartime veterans and surviving spouses may qualify for programs like Aid and Attendance that offset care costs. Your county’s veterans service office can check eligibility for free.
- Life insurance and annuities — some policies can convert toward care costs. Get independent advice before cashing anything in.
Questions to ask any facility about money
The money checklist
- What is the daily rate, and exactly what does it include?
- Do you accept Medicaid? If savings run out, can my loved one stay in the same bed?
- Which insurance plans are you in network with?
- What happens on day 101, or when covered rehab days end?
- Are there admission fees, deposits, or extra charges we should expect?
- Can we have the full fee schedule in writing?
Facilities answer these questions all day — a good admissions office will walk you through them without flinching. If the money answers feel evasive, that tells you something too.