How to Pay for Senior Care

Paying for senior care almost never comes from one place. Most families stitch together several payers: Medicaid, Medicare, VA benefits, and private money. Each one covers different care, for different people, under different rules. This guide explains who pays for what, who qualifies, and how the pieces fit together.

Start with the five payers below. Then read the deeper section on whichever one fits your family.

What Senior Care Costs

Before you figure out who pays, know the bill. These are national medians for 2026. Your state and metro area can run well above or below them.1

These figures come from the CareScout 2025 Cost of Care Survey, released March 2, 2026, the most recent national data.1 In that survey, the semi-private nursing home rate rose 2% and assisted living rose 5%; cost growth slowed in 2025 after several years of steeper increases. The 2025 survey also merged homemaker and home health aide services into one "non-medical caregiver" category, priced at about $35 an hour. At about $9,581 a month, two years in a semi-private nursing home room runs past $229,000. That math is why almost every middle-class family ends up combining payers.1

Who Pays for What: How to Pay for Senior Care at a Glance

Here's the quick comparison. Each payer is broken out in detail below.

Medicaid

Medicaid is the biggest payer for long-term senior care in the country. It covers nursing home care, in-home services, and care services in assisted living for people who qualify financially and medically. It's the payer most families land on once savings run low.

Because Medicaid is means-tested, eligibility turns on income and assets. A single applicant for long-term care Medicaid generally needs countable assets under about $2,000 and monthly income at or below roughly $2,982 (300% of the federal Supplemental Security Income (SSI) benefit rate).2 A few rules matter most:

• Spousal protections. When one spouse needs care and the other stays home, the at-home spouse can keep a share of the couple's assets. For 2026 that Community Spouse Resource Allowance (CSRA) runs from a $32,532 minimum to a $162,660 maximum, depending on the state, plus a monthly income allowance of up to $4,066.50.3
• The home equity cap. The primary home is usually exempt, but only up to an equity limit. For 2026 that cap ranges from $752,000 to $1,130,000, set by each state.4
• The 5-year look-back. Medicaid reviews 60 months of financial records before the application date. Gifts or below-market transfers in that window trigger a penalty period when Medicaid won't pay.5

These rules are where families make expensive mistakes, and where legal planning can protect assets. The mechanics get detailed, so we cover them separately rather than repeating them here. See our guides to Medicaid planning strategies and estate recovery.

Medicare

This is where families get surprised. Medicare does not pay for long-term care.

What Medicare covers is short-term skilled care. After a qualifying inpatient hospital stay of at least three days, Medicare Part A covers up to 100 days in a skilled nursing facility per benefit period: days 1 through 20 in full, days 21 through 100 with a daily copay, and nothing after day 100.6 It also covers home health visits for skilled nursing and therapy when a doctor orders them.

What it doesn't cover is custodial care: ongoing help with bathing, dressing, eating, and other daily activities when that's the only care needed.6 Assisted living, long-term nursing home stays, and non-medical home care all fall outside Medicare. For those, families rely on Medicaid, VA benefits, insurance, or private pay.

VA Benefits and Aid and Attendance

If your loved one is a wartime veteran or the surviving spouse of one, the VA can add real money each month. The benefit is called VA Aid and Attendance (A&A), a pension add-on for those who need help with daily living.

The 2026 monthly maximums, effective through November 30, 2026, are:7

• Veteran with no dependents: up to $2,424 a month7
• Veteran with one dependent: up to $2,874 a month7
• Surviving spouse: up to $1,558 a month7

To qualify, the veteran must have served during a wartime period, need help with daily activities, and fall under a net worth limit of $163,699 (the home, vehicles, and basic household goods don't count).7 The VA applies a 3-year look-back on asset transfers, separate from the Medicaid look-back. This money can go toward any care setting: home care, assisted living, or a nursing home.

Private Pay

When government programs and insurance don't cover everything, families pay the rest themselves. Here are the four most common sources.

Out-of-Pocket and Savings

Most families start here. Retirement accounts, pensions, and Social Security income are the usual sources. The risk is duration: long-term care can last years, and at the costs above, savings drain fast. Plan for how long the money lasts, not just whether it covers the first month.

Long-Term Care Insurance

If your loved one bought a long-term care policy years ago, this is when it pays off. These policies cover home care, assisted living, and nursing home care up to a daily or monthly benefit. Dig out the policy now and read the benefit triggers, daily maximum, and elimination period before you need it. New policies are expensive and hard to qualify for after 65, so this is mostly a tool for people who planned ahead. The federal consumer resource at longtermcare.acl.gov explains how these policies work.

Reverse Mortgages

For homeowners 62 and older, a reverse mortgage converts home equity into cash with no monthly mortgage payment. The federally insured version is the Home Equity Conversion Mortgage (HECM). It can fund home care or assisted living while the borrower stays in the house. Watch the interaction with Medicaid: money you pull out but don't spend in the month received counts as an asset the next month, which can push you over the limit.

Life Insurance

An existing life insurance policy can sometimes fund care. Some policies offer an accelerated death benefit that pays out early if the policyholder is terminally ill or needs long-term care. Others can be sold through a life settlement for a lump sum, or borrowed against if they carry cash value. Check the policy terms before assuming any of these apply.

Next Steps: How to Pay for Senior Care

Work it in this order:

Your state changes the details: limits, waitlists, and which programs exist. Read your state's guide for the specifics.

Paying for Senior Care in Your State

The five payers above are national, but what your family actually pays comes down to where your loved one lives. States run their own Medicaid programs, keep their own waiting lists, and tax retirement income and property differently, so the same five payers add up differently from one state to the next. Your state guide walks through how they fit together locally.

Learn More

Find personalized help figuring out how to pay for senior care 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.