Assisted living and a nursing home solve different problems, and the difference decides both what you pay and who pays. Assisted living is custodial help with daily life; a nursing home provides around-the-clock skilled nursing care. Two things about that choice depend heavily on where you live: whether Medicaid will help with the bill, and how the place is regulated. This guide compares the two on care, cost, coverage, and regulation, then points you to a full guide for your state.

In This Guide

The Core Difference

The two settings serve people with different levels of need.

Assisted living is for someone who needs help with daily life but not constant medical care. It provides custodial, personal-care support, help with activities of daily living such as bathing, dressing, and eating, along with meals, housekeeping, and a social setting. Some communities offer limited health care, but assisted living generally isn't a medical setting.

A nursing home, also called a skilled nursing facility, provides 24-hour licensed nursing and medical oversight for people who need that level of care; federal rules require a nursing home to have licensed nurses on a 24-hour basis. Medicare's skilled-nursing benefit covers a nursing-home stay only on a short-term, post-acute basis, never long-term custodial care, so families cover a longer stay through private pay, long-term care insurance, VA benefits, or, for people who meet their state's rules, Medicaid. In short: assisted living helps you live; a nursing home treats and monitors a medical need.

Assisted Living vs. Nursing Home: Side by Side

The two settings differ on every axis a family weighs: the level of care, who it's built for, staffing, cost, whether Medicaid helps, and how it's regulated. Here is the comparison at a glance.,,,,,,,

Assisted living Nursing home (skilled nursing facility)
Level of care Custodial: help with daily activities like bathing, dressing, and meals, not constant medical care 24-hour licensed skilled nursing and medical oversight
Who it's for Someone who needs help with daily life but is medically stable Someone who needs ongoing skilled nursing or cannot be safely cared for in a lighter setting
Staffing Personal-care aides and support staff, not a medical team Licensed nurses on site around the clock
Typical cost (national median) About $6,200 a month ($74,400 a year) About $315 a day, or $114,975 a year (semi-private); about $355 a day, or $129,575 a year (private)
Does Medicaid pay? Only where the state has elected home and community-based services, and not for room and board Yes: a mandatory benefit in every state's Medicaid plan, for people who qualify
How it's regulated Licensed state by state, so requirements vary One federal set of requirements for Medicare- and Medicaid-certified homes (Social Security Act sections 1819 and 1919), inspected by state survey agencies

The rows on cost, coverage, and regulation are the ones that shift most from state to state. The sections below take each in turn.

What Each Costs

The price gap is large. In CareScout's 2025 Cost of Care Survey, released in March 2026 and the most recent national data, the national median for assisted living was $6,200 a month, or $74,400 a year. A semi-private nursing home room ran $315 a day, or $114,975 a year, and a private room $355 a day, or $129,575 a year. Set side by side as yearly costs, a nursing home runs roughly one and a half to one and three-quarters times the cost of assisted living, which is one reason the who-pays question below matters so much. These are medians, not price quotes: what you pay depends on the care needed, the providers near you, and where you live.

Who Pays: The Medicaid Difference

This is where your state comes in. Under federal law, nursing-facility care for people 21 and older is a mandatory Medicaid benefit, so it is part of every state's Medicaid plan, though you still have to qualify. Assisted living is different. Home and community-based services (HCBS), the Medicaid benefits that can pay for care outside a nursing home, are optional: they exist only where a state has elected them, through its state plan or a waiver. A waiver can be limited to specific groups and capped at a set number of people, which is what produces waiting lists, so living in a state that covers HCBS doesn't guarantee a spot. So whether Medicaid helps with assisted living depends on your state; check your state's program.

One rule holds everywhere: federal Medicaid law does not cover room and board in home and community-based settings such as assisted living. Even where a waiver pays for the personal care and support services a resident gets, the resident remains responsible for the housing-and-meals part of the bill.

How They're Regulated

The oversight is as different as the coverage. Under Social Security Act sections 1819 and 1919 and the federal rules at 42 CFR part 483, a nursing home that takes Medicare or Medicaid is measured against the same body of federal participation requirements anywhere in the country, and those requirements are the basis for its inspections. State survey agencies do the inspecting under CMS guidance, and CMS can fine a facility that falls short or, in some cases, end its participation. Assisted living is licensed and regulated at the state level, and state requirements vary considerably, so what "assisted living" means and requires changes from state to state. The one federal overlay is a 2014 CMS rule setting standards for residential care settings that receive Medicaid payment; it is a condition of Medicaid payment, not a national licensing standard, and it doesn't reach a setting that takes no Medicaid money. That variation is a big reason to check the rules where you live.

Find Your State

Don't try to learn all fifty. Learn yours. Pick your state for a full assisted-living-vs-nursing-home guide: what each covers, who pays where you live, and how to find care.

Find Your State's Assisted Living vs. Nursing Home Guide

AlabamaView guide AlaskaView guide ArizonaView guide ArkansasView guide CaliforniaView guide ColoradoView guide ConnecticutView guide DelawareView guide District of ColumbiaView guide FloridaView guide GeorgiaView guide HawaiiView guide IdahoView guide IllinoisView guide IndianaView guide IowaView guide KansasView guide KentuckyView guide LouisianaView guide MaineView guide MarylandView guide MassachusettsView guide MichiganView guide MinnesotaView guide MississippiView guide MissouriView guide MontanaView guide NebraskaView guide NevadaView guide New HampshireView guide New JerseyView guide New MexicoView guide New YorkView guide North CarolinaView guide North DakotaView guide OhioView guide OklahomaView guide OregonView guide PennsylvaniaView guide Rhode IslandView guide South CarolinaView guide South DakotaView guide TennesseeView guide TexasView guide UtahView guide VermontView guide VirginiaView guide WashingtonView guide West VirginiaView guide WisconsinView guide WyomingView guide
51 states

Frequently Asked Questions

What's the difference between assisted living and a nursing home?

Assisted living is custodial care, help with daily activities, meals, and supervision, for people who don't need constant medical care. A nursing home provides 24-hour licensed nursing and medical oversight.

Which is more expensive, assisted living or a nursing home?

A nursing home. In CareScout's 2025 survey, released in March 2026, the national median for assisted living was $6,200 a month ($74,400 a year), while a semi-private nursing home room ran $315 a day ($114,975 a year) and a private room $355 a day ($129,575 a year).

Does Medicaid cover assisted living?

Only in some states. Medicaid can pay for assisted-living services only where a state has elected home and community-based services, and a waiver can cap enrollment. Federal Medicaid law does not cover assisted-living room and board., Check your state's program.

Does Medicaid cover nursing homes?

Yes, for people who qualify. Nursing-facility care is a mandatory Medicaid benefit, so it is part of every state's Medicaid plan.

How do I choose between them?

Match the setting to the level of care needed: assisted living if someone needs help with daily life, a nursing home if they need skilled nursing. Then check your state's Medicaid coverage and the local rules using the directory above.

Learn More

Care TypesThe Cost of Senior Care by StateThe 2026 national median cost of assisted living, memory care, nursing homes, and in-home care, why your state differs, and your state's own cost guide. Care TypesAssisted Living by StateWhat assisted living costs, how licensing and Medicaid coverage differ from state to state, plus a guide to all 50 states so you can jump straight to yours. FinancialHow to Pay for Senior CareHow to pay for senior care: what it costs nationally and how Medicaid, Medicare, VA benefits, and private pay each fit. Who qualifies, what's covered, in 2026.
Your next step Weighing assisted living against a nursing home for a parent? Brevy's care navigator can help you compare the options and costs in your state.

Find personalized help understanding your care options at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

Still have questions?

Brevy answers from this guide and every other guide here, and can check what you qualify for.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.