Hawaii's median cost for assisted living is $145,155 a year in CareScout's 2025 Cost of Care Survey, the highest assisted living median of any state. If you are trying to work out how to pay for senior care in Hawaii, that number can make the whole plan feel out of reach before it starts. You won't be paying that bill from one pocket. The sources to line up are your parent's own income, savings and home; Medicare, for a short skilled stay after a hospital admission; Med-QUEST, Hawaii's Medicaid program, once savings run low; and any veterans' benefits or insurance policy your parent already holds. Med-QUEST is also more open than it first looks: a Hawaii applicant with income over its limit can still qualify through the Medically Needy Spenddown program.

In This Guide

What Senior Care in Hawaii Costs

Before you weigh any program, it helps to know the size of the bill you are planning around, even if the numbers are hard to look at. Each of the five Hawaii settings in the table below runs above CareScout's national median for the same setting, and a separate CareScout analysis comparing its 2022 and 2025 surveys ranked Hawaii No. 1 in the country for the fastest-rising senior care costs.

Setting in Hawaii Yearly median Monthly or hourly median
Non-medical caregiver at home $93,808 $41 an hour
Assisted living community $145,155 $12,096 a month
Nursing home, semi-private room $185,679 $15,473 a month
Nursing home, private room $196,735 $16,395 a month
Adult day health care $30,615 $2,551 a month

For comparison, CareScout's 2025 national median for assisted living is $74,400 a year, or $6,200 a month. These are industry-survey medians rather than government figures, and costs in Hawaii vary across the islands and climb as care needs grow. Our guide to the cost of senior care in Hawaii breaks the figures down setting by setting, and Hawaii nursing homes covers choosing a facility.

Paying for Senior Care in Hawaii From Your Parent's Income, Savings and Home

For now, your parent's own money is the first thing that pays: Social Security, a pension, savings and sometimes the house. Before drawing savings down, check how much of that money Hawaii's tax rules and your parent's county let the family keep.

How Hawaii Taxes Retirement Income

Hawaii does not tax Social Security benefits. Pensions depend on who funded them. Under Hawaii Revised Statutes (HRS) 235-7(a)(3), Hawaii excludes a pension for past services from taxable income when it is employer-funded, and the Hawaii Department of Taxation's Tax Information Release (TIR) 96-5 treats a pension funded by mandatory, nonelective employee contributions as employer-funded too, so it stays excluded. Money your parent chose to put in is different: under TIR 96-5, a distribution from salary-reduction 401(k) deferrals is taxable in Hawaii when paid out, and so is a distribution from an IRA your parent funded personally rather than by rollover. Benefits from Hawaii's state retirement system and other public retirement systems are excluded under a separate provision, HRS 235-7(a)(2). The full rules, including the rate schedule, are in our guide to how Hawaii taxes retirement income.

County Home Exemptions for Older Owners

In Hawaii, property tax relief for seniors comes from the four counties, not the State, and each county sets its own owner-occupant home exemption. Three of Hawaii's four counties (the City and County of Honolulu, Hawaii County and Kauai County) raise the owner-occupant home exemption as the owner gets older.

County Home exemption Higher amount with age When to file
City and County of Honolulu (Oahu) $120,000 off assessed value $160,000 at 65 or older Check the county's posted filing deadline
Hawaii County (Big Island) $50,000, plus 20 percent of assessed value capped at $100,000 $85,000 at 60, $90,000 at 65, $105,000 at 70, $110,000 at 75, $125,000 at 80 or over By December 31 for the first-half payment or June 30 for the second half
Maui County $300,000, flat None; the former age exemption was eliminated By December 31 of the preceding assessment year
Kauai County $220,000 $240,000 at 60, $260,000 at 70 By September 30 preceding the tax year

Honolulu's home exemption amounts rise to $140,000, or $180,000 at 65 or older, effective July 1, 2027. Kauai County adds a separate $120,000 exemption for owner-occupants whose combined annual gross income stays within 80% of the Kauai median household income, and it must be claimed each year by September 30. Maui County and Hawaii County each require the owner to have filed a Hawaii resident income tax return. If your parent lives on Oahu and has turned 65, confirm the home exemption claim is on file with the City and County of Honolulu's Real Property Assessment Division, and check its home exemption page for the current filing deadline. County-by-county filing detail is in our guide to Hawaii senior property tax relief.

If Your Parent Is a Disabled Veteran Who Owns a Home

Hawaii's disabled-veteran property tax exemptions are county programs too. In the City and County of Honolulu, a home owned and occupied by a veteran totally disabled by injuries received in the U.S. Armed Forces is exempt from real property taxes except the minimum tax, and the exemption continues if the veteran, or a qualifying widow or widower, moves into a licensed long-term care facility or adult residential care home in Hawaii. To keep Honolulu's disabled-veteran exemption during a long-term care stay, the owner must name the facility on the claim form, and the original home cannot be rented, leased or sold during the stay. Maui County's exemption requires a disability rating of 70 percent or higher from the U.S. Department of Veterans Affairs (VA), and Kauai County's covers a veteran who is 80 percent to totally disabled due to injuries received on duty. More: Hawaii property tax exemptions for disabled veterans.

Borrowing Against the House

Any loan against the house is secured by it and shrinks the equity your parent or the heirs would otherwise keep. The federally insured Home Equity Conversion Mortgage (HECM), a reverse mortgage, is open to homeowners 62 and older through a lender approved by the Federal Housing Administration (FHA) and needs no monthly mortgage payments, but interest and fees are added to the balance each month, so what is owed grows while the equity falls. Timing matters more than anything for a family paying for care. If a HECM borrower spends more than 12 consecutive months in a healthcare facility such as a nursing home or assisted living facility and no co-borrower lives in the home, anyone else living there must move out unless they can repay the loan or qualify as an Eligible Non-Borrowing Spouse. The 12-month rule is why a HECM suits care at home, or a couple where one spouse stays in the house, better than one person's permanent move into a facility. More: home equity options for senior care.

Trying to sort out which of these your parent can use? Chat with Brevy's care navigator at brevy.com.

How Far Medicare Goes

It is easy to assume Medicare will carry a long nursing home stay in Hawaii, and finding out otherwise in the middle of a crisis hurts. Medicare does not cover custodial care, the non-medical help with bathing, dressing and using the bathroom, when that is the only care a person needs, and that is why Medicare does not pay for a long-term stay in a nursing home or an assisted living facility.

What Medicare Part A does pay for is skilled nursing facility care on a short-term, post-acute basis, up to 100 days per benefit period, generally after a qualifying inpatient hospital stay of at least three consecutive days. Time under observation or in the emergency room before admission does not count toward Medicare's three-day qualifying hospital stay, even overnight. A patient whose doctor belongs to an Accountable Care Organization approved for a Skilled Nursing Facility 3-Day Rule Waiver may not need the three-day stay, and a Medicare Advantage plan may waive it as well.

In 2026, Medicare Part A charges $0 a day for skilled nursing facility days 1 through 20 after the $1,736 deductible (not owed again if your parent already paid it for hospital care in the same benefit period), $217 a day for days 21 through 100, and pays nothing after day 100. If your parent will need care past day 100, start the Med-QUEST application while the Medicare days are still running. See also Medicare plans and coverage in Hawaii.

Paying for Senior Care in Hawaii With Med-QUEST

When savings start to run thin, Med-QUEST is the program that pays for long-term care in Hawaii. Med-QUEST, Hawaii's Medicaid program, delivers long-term care through its QUEST Integration managed-care program, which covers institutional care and home- and community-based long-term services and supports based on medical necessity and clinical criteria. Getting Med-QUEST long-term services and supports takes an additional application and a level-of-care evaluation your parent completes with a physician.

Income and assets. Med-QUEST determines eligibility for people 65 and older, or blind or disabled, on income up to 100 percent of the federal poverty level and assets up to $2,000 for a single-person household or $3,000 for a household of two. A Hawaii applicant age 65 or older whose income is above 100 percent of the federal poverty level, with assets within Med-QUEST's $2,000 (single) or $3,000 (couple) limit, may still qualify under Med-QUEST's Medically Needy Spenddown program if their medical expenses are greater than the spenddown amount Med-QUEST determines. If someone has told you your mother's pension makes her too well off for Medicaid, that spenddown route is the thing to ask Med-QUEST about before you accept the answer. Income dollar figures and what counts are in our guide to Hawaii Medicaid income and asset limits.

Bills from before you applied. For a person requesting long-term care services, Med-QUEST can pay outstanding medical bills from up to three months before the application date, compared with ten days for other applicants. If the paperwork is running behind the care, keep every bill from those months.

Home equity. Under federal Medicaid law, an applicant whose home equity is over the 2026 minimum of $752,000 is not eligible for long-term care assistance, and a state may substitute a higher limit of up to $1,130,000, so ask Med-QUEST which figure it uses. The federal equity limit does not apply at all while a spouse, a child under 21, or a child who is blind or permanently and totally disabled lawfully lives in the home.

How Med-QUEST handles a nursing home stay, including what a resident keeps each month, is in our guide to Hawaii Medicaid and nursing home care. Our guide on how to apply for Hawaii Medicaid walks through the forms, and if a decision goes against your parent, read Hawaii Medicaid appeals and fair hearings the day the notice arrives.

Gifts and Transfers in the Last Five Years

Under federal Medicaid law, an asset given away for less than fair market value is checked against a look-back of 60 months, counted back from the date the person is both institutionalized and has applied for Medicaid. A transfer inside Medicaid's 60-month look-back can trigger a penalty period, worked out by dividing the total uncompensated value by the state's average monthly private-pay cost of nursing facility care. A Medicaid transfer penalty blocks nursing facility and home and community-based waiver services for those months, not all of a person's Medicaid coverage.

Not every transfer is penalized. Federal law lets a home pass without penalty to a spouse; to a child under 21 or a child who is blind or permanently and totally disabled; to a sibling with an equity interest who lived there at least one year before the institutionalization; or to a son or daughter who lived there at least two years before it and provided care that let the parent stay home instead of in a facility. Ask Med-QUEST how it applies the look-back to your parent's application. Money moved in a hurry is hard to undo, so talk with a Hawaii elder law attorney before anyone retitles the house or writes a large check.

What Happens to the Family Home

Federal law limits when a state Medicaid program such as Med-QUEST can recover from an estate: only after the death of a surviving spouse, and only when no surviving child is under 21 or blind or permanently and totally disabled. Every state Medicaid agency must also have procedures to waive recovery where it would work an undue hardship. How Med-QUEST applies those rules is in our guide to Hawaii Medicaid estate recovery.

Care at Home or in Assisted Living

If your parent would rather stay in their own home, that choice runs through the same Hawaii program. Choosing care at home does not mean a separate program: home- and community-based long-term services and supports come through the same QUEST Integration coverage, and the same Med-QUEST long-term care application, described above. The services, the clinical test and how to enroll are in our guide to Hawaii Medicaid HCBS waivers.

If assisted living is the plan, read our guide on how to pay for assisted living in Hawaii before you tour, so you know which part of the monthly bill each program will and won't touch. If a family member is the one doing the caregiving, see how to get paid as a family caregiver in Hawaii and caregiver programs in Hawaii.

When One Spouse Stays Home

When a husband or wife needs long-term care, the spouse still living at home is not expected to hand over everything. Federal law sets the community spouse resource allowance for the spouse at home as the greatest of several amounts, including a higher amount a state plan may specify, a fair-hearing amount or a court-ordered amount. For 2026, the Centers for Medicare & Medicaid Services (CMS) sets the floor in that formula at $32,532 and the ceiling at $162,660. How Med-QUEST works out the protected amount, and how to ask for more, is in our guide to Hawaii Medicaid spousal impoverishment rules.

If Your Parent Is a Veteran

If your parent or their spouse served, VA benefits may belong in the plan, and the current rules and rates are in our guide to VA Aid and Attendance in Hawaii.

Is your parent a veteran or a veteran's surviving spouse? Chat with Brevy's care navigator at brevy.com to see which benefits might apply.

Long-Term Care Insurance

If your parent bought a long-term care insurance policy years ago, find it now and read three things: what triggers benefits, the daily maximum and the waiting period. Per-diem benefits from a tax-qualified long-term care insurance policy are excluded from federal income only up to the greater of an indexed amount, $430 a day for 2026, or the actual cost of care, so the cap matters only when a policy pays more per day than the care costs. On the Medicaid side, a long-term care insurance partnership can shelter assets, but it exists only in a state with an approved Medicaid state plan amendment for it, so ask the insurer and Med-QUEST in writing whether your parent's policy is a partnership policy. More: long-term care insurance.

Once you have the list of what your parent has, paying for elder care in Hawaii becomes a set of calls to make rather than one impossible number. If your parent is on Medicare with a modest income, check Hawaii Medicare Savings Programs too.

Frequently Asked Questions

If my parent gets SSI, does that mean they qualify for Hawaii Medicaid?

Not automatically. Hawaii is one of the eight 209(b) states, which use at least one eligibility rule stricter than Supplemental Security Income (SSI), so an SSI award does not by itself establish Hawaii Medicaid eligibility. In exchange, a 209(b) state like Hawaii must let an applicant deduct incurred medical expenses from income through a Medicaid spenddown.

Does Medicare pay again if my parent leaves a skilled nursing facility and has to go back?

It can. If your parent re-enters the same or another skilled nursing facility within 30 days of leaving, Medicare does not require a new three-day qualifying hospital stay, and the same holds if skilled care stops and restarts within 30 days.

Does rolling my father's pension into an IRA change how Hawaii taxes it?

No. Under the Hawaii Department of Taxation's TIR 96-5, a rollover IRA is treated as a continuation of the employer plan the money came from, so rolling an employer-funded pension into an IRA does not forfeit Hawaii's exclusion.

Is Hawaii's estate tax the same thing as Medicaid estate recovery?

No, they are separate. Hawaii's estate tax applies only to estates above a $5,490,000 exclusion, at graduated rates from 10 percent up to a top rate of 20 percent, and it is separate from both the federal estate tax and Medicaid estate recovery. Hawaii has no inheritance tax. See Hawaii estate tax.

Can a home equity line of credit stop paying out while we're using it for care?

Yes. A lender might refuse further credit under a home equity line of credit if the home's value drops significantly, and might freeze additional draws if the borrower's finances change and the lender doubts they can make the payments. Plan for that before counting a line of credit as the money for a long stay.

Learn More

Care TypesCost of Senior Care in HawaiiWhat senior care costs in Hawaii in 2026: a private nursing-home room reached about $196,735 a year, the highest in the U.S. See every setting and how to pay. MedicaidHawaii Medicaid and Nursing Home CareHow Hawaii Medicaid nursing home coverage works in 2026: Med-QUEST eligibility, the asset limit, the spend-down income path, and estate recovery. MedicaidHawaii Medicaid HCBS WaiversHow Hawaii Medicaid HCBS waivers work in 2026: QUEST Integration home care, who qualifies, covered services, the $2,000 asset limit, and how to apply. Care TypesHow to Pay for Assisted Living in HawaiiPay for assisted living in Hawaii using private pay, long-term care insurance, VA Aid and Attendance, and Med-QUEST. A worked plan with 2026 figures. VA BenefitsVA Aid and Attendance in HawaiiVA Aid and Attendance in Hawaii for 2026: who qualifies, monthly rates up to $2,874, how to apply, and where the state Office of Veterans' Services can help. FinancialHawaii Senior Property Tax ReliefHawaii senior property tax relief runs from a $160,000 Honolulu exemption to Maui's flat $300,000. Each county sets its own rules and deadlines.

Find personalized help paying for senior care in Hawaii 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.

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Brevy Care Team

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