How to Pay for Senior Care in Tennessee (2026)

Working out how to pay for senior care in Tennessee usually starts with a hard number: the American Council on Aging puts a shared room in a Tennessee nursing home at $109,865 a year. SeniorLiving.org's June 2026 table runs higher still, at $9,681 a month.1 That is hard to cover out of pocket for long, and paying it rarely means relying on one source. Private savings, TennCare, veterans benefits, and insurance can each cover part of the cost, and the mix tends to shift as savings run down and care needs rise.

This guide walks through every realistic way to pay for senior care in Tennessee in 2026, who qualifies for each, and what each one actually covers.

In This Guide

• Key Takeaways
• What Senior Care Costs in Tennessee
• Paying Out of Pocket
• What Medicare Does and Doesn't Cover
• TennCare CHOICES: Medicaid Long-Term Care
• VA Aid and Attendance for Veterans
• Long-Term Care Insurance and the Tennessee Partnership
• Other Ways to Pay for Senior Care in Tennessee
• Frequently Asked Questions

What Senior Care Costs in Tennessee

Before working out how to pay, it helps to see what you're paying for. Tennessee care costs come from private survey publishers rather than government data, and those publishers do not agree with each other, so read every number below as a starting range rather than a price. For nursing home care, two publishers give Tennessee figures. SeniorLiving.org's state table, updated June 2026, puts a Tennessee semiprivate room at $9,681 a month and a private room at $10,456 a month, and shows a 4 percent median annual increase for both. The American Council on Aging, estimating for 2026 and last updated in March 2026, puts Tennessee lower: $109,865 a year for a shared room and $116,545 a year for a private room, and it puts Nashville higher, at $118,625 a year for a shared room and $138,700 a year for a private room.1 For home care, the CareScout Cost of Care Survey page we rely on gives only national medians, because its Tennessee figures sit behind an interactive selector, so there is no Tennessee home care median to quote here.1 Assisted living is the exception: CareScout's own median cost data tables for the same 2025 survey do give a Tennessee figure, covered just below the table.6

The assisted-living figure above is worth a closer look, because it changes the arithmetic. It comes from CareScout's own median cost data tables for the 2025 Cost of Care Survey: $70,140 a year, or $5,845 a month, for an assisted living community in Tennessee. That is below the national median of $74,400 a year ($6,200 a month), but only modestly, so don't budget as if Tennessee were far cheaper than the rest of the country. None of our sources gives a metro-by-metro assisted living figure for Tennessee, so ask each community for its own rate sheet rather than working from a Nashville or Knoxville average.6 Nursing home care costs more again: at roughly $110,000 a year and up, a two-year nursing home stay runs past $200,000. That gap between what care costs and what a household can pay from savings is why it pays to know every funding source below rather than lean on any single one.1

Paying Out of Pocket

Many families start with private pay, drawing on Social Security, pensions, retirement savings, and home equity. For a while it may be the only option, especially while a care plan is still taking shape or before TennCare eligibility lines up.

A few private-pay tools Tennessee families use:

• Home equity. A homeowner can sell, rent out, or borrow against the home. A federally insured reverse mortgage (a HECM) turns equity into cash. It is open only to borrowers 62 or older who also meet further requirements, such as living in the home as their principal residence and getting counseling from a HUD-approved agency first. The loan balance grows each month and must be repaid, usually by selling the home, once the last borrower or eligible non-borrowing spouse dies, sells, or no longer lives there as a principal residence, and sooner if property taxes or homeowners insurance go unpaid or the home isn't kept in good repair.7 TennCare excludes a principal residence from its resource test, within the limits described below, so weigh any sale or loan against a future TennCare application before acting.3
• Life insurance. Some policies include an accelerated death benefit that pays part of the death benefit early, usually only if the feature was added before the insured became terminally ill, so ask the insurer or agent whether the policy offers it rather than counting on adding it once care is needed. A policy can also sometimes be sold to a third-party investor in a life settlement, for a lump sum that is generally more than its cash surrender value but less than its death benefit, an option usually open only to women about 74 and older and men about 70 and older. Either move can have tax consequences and can affect Medicaid eligibility.8
• Long-term care insurance. If your family member bought a policy years ago, it can start paying once its benefit trigger is met and its waiting period has passed.9 Tennessee's Partnership program (below) makes some of these policies especially worth keeping.

The hard truth is that private pay drains savings fast at care prices. Many families treat it as a bridge while they line up TennCare, VA benefits, or other coverage, and that early planning is what protects the rest of a household's money.

What Medicare Does and Doesn't Cover

This is where many families are caught off guard. Medicare does not pay for long-term care: the ongoing help with daily activities such as bathing, dressing, and using the bathroom, which medicare.gov also calls custodial care.2

What Medicare does cover is limited and medical:

• Skilled nursing facility care for up to 100 days in each benefit period after a qualifying hospital stay, when a doctor decides the person needs daily skilled care.2 In 2026 the coinsurance is $217 a day for days 21 through 100.10
• Home health care (part-time or intermittent skilled nursing or therapy) when a doctor or allowed practitioner sets up a plan of care, the person is certified as homebound, and the care comes from a Medicare-certified home health agency.11
• Hospice care when the hospice doctor (and the person's regular doctor, if they have one) certifies a terminal illness with a life expectancy of six months or less, and the person chooses comfort care from a Medicare-approved hospice instead of other Medicare-covered treatment for that illness.12

What Medicare doesn't cover is the custodial, long-term side of care, whether it's given at home, in the community, in assisted living, or in a nursing home. Medicare.gov itself points families to Medicaid, which is TennCare here, or to private long-term care insurance instead.2 For how Medicare itself works in this state, including Medicare Advantage, Medigap, and programs that lower your premiums, see our guide to Medicare plans and coverage in Tennessee.

TennCare CHOICES: Medicaid Long-Term Care

When private pay runs out, TennCare is the public program that can step in for people who qualify. Medicaid is the federal-state program behind it; in Tennessee it goes by the name TennCare, and its long-term care program is TennCare CHOICES. CHOICES brings all nursing facility care and home and community based services into TennCare's managed care system.3 A current TennCare member can ask their health plan (BlueCare, UnitedHealthcare Community Plan, or Wellpoint, formerly Amerigroup) how to apply for CHOICES.6

CHOICES covers care in two broad settings:

• Nursing facility care (CHOICES Group 1) for people who meet the nursing-home level of care and the financial rules.3
• Home and community based services for Group 2 (people who meet the nursing-home level of care but receive care at home instead) and Group 3 (people who don't meet it but are at risk of needing nursing home care). Services include personal care (up to 2,580 hours a calendar year), adult day care (up to 2,080 hours a calendar year), and home-delivered meals (up to one meal a day).13 Assisted care living facility services are covered for Groups 2 and 3, but the member pays their own room and board.6

Who Qualifies in 2026

CHOICES has both a functional test and a financial test. Groups 1 and 2 require a nursing-home level of care, Group 3 requires being at risk of needing it, and Groups 2 and 3 are for people 65 and older or adults 21 and older with a disability.6 For Groups 1 and 2, the financial rules are strict:3

• Income: gross income up to $2,982 a month for the applicant, TennCare's Medicaid Income Cap, which is 300 percent of the $994 federal SSI benefit rate. Someone over that limit isn't automatically shut out: TennCare gives them the chance to set up a Qualified Income Trust (often called a Miller trust) to redirect the excess, and then tests income eligibility again.3
• Resources: up to $2,000 in countable resources for the applicant. Several things don't count toward that, including one vehicle used for transportation and the home (below).3
• Spousal protection: the at-home spouse can keep one-half of the couple's total countable resources, which for a January 2026 snapshot is bounded at no less than $32,532 and no more than $162,660. TennCare calls this the Community Spouse Resource Maintenance Allowance, and a court order or an appeals officer's hardship ruling can set a higher amount.3
• The home: a principal residence is excluded while the applicant, a spouse, or a dependent relative lives there, or, for someone in a nursing home, while they intend to return. For CHOICES, though, home equity above $752,000 makes an applicant ineligible unless a spouse, a child under 21, or a blind or disabled child lives in the home, and TennCare can waive the limit for undue hardship.3

One rule trips up families who give money away to qualify: TennCare applies a 60-month look-back to asset transfers, counted back from the application, under federal Medicaid law.14 A transfer for less than fair market value in that window can trigger a penalty period during which TennCare won't pay for long-term services and supports, such as nursing home care or CHOICES home care, though the penalty doesn't withdraw the rest of a person's coverage. Some transfers, such as one to a spouse, are exempt. Plan transfers well ahead, or not at all.14

For the full eligibility picture and how to apply, see our guides to TennCare CHOICES and Tennessee Medicaid for long-term care and nursing homes.

VA Aid and Attendance for Veterans

If your loved one is a veteran who served during a wartime period, or the surviving spouse of one, VA Aid and Attendance can be a real funding source. It is paid through the VA pension: a veteran may qualify if they get a VA pension and meet at least one Aid and Attendance requirement, such as needing another person's help with daily activities like bathing, feeding, and dressing.5 VA describes it as monthly payments added to a pension, but it works as a higher ceiling rather than a second check: the Aid and Attendance maximum annual pension rate replaces the basic rate instead of paying on top of it.6

For the rate year that began December 1, 2025, VA publishes these maximum annual pension rates for Aid and Attendance:

• Veteran with no dependents: up to $29,093 a year.4
• Veteran with one dependent: up to $34,488 a year.
• Surviving spouse with no dependents: up to $18,697 a year.

These are yearly maximums, and VA pays pension monthly: the monthly amount is the yearly maximum minus countable income, divided by 12 and rounded down to the whole dollar.4

Aid and Attendance is need-based, so the actual payment is the maximum rate minus countable income. Non-reimbursable medical expenses can reduce countable income, but only the part above 5 percent of the maximum rate counts. The net worth limit from December 1, 2025 to November 30, 2026 is $163,699, and there's a 3-year look-back on assets transferred for less than fair market value, shorter than TennCare's five years.4 Not every such transfer draws a penalty: it has to be an asset that would otherwise have pushed net worth over the limit, and the penalty period can run up to five years.5 A Tennessee veteran or surviving spouse can receive Aid and Attendance and TennCare at the same time, so a veteran's family should check it early rather than assume they earn too much.6 One limit matters for nursing home care: a veteran with no spouse or dependent child, or a surviving spouse with no dependent child, whose nursing facility care TennCare covers can be paid no more than $90 a month in VA pension after the month of admission, though a stay in a State Veterans Home for which VA pays a nursing home per diem can fall outside that cap, so check with an accredited Veteran Service Officer. Once VA has reduced the pension to $90, TennCare treats that $90 as aid and attendance and does not count it toward what the resident owes the facility, but a pension VA is still paying at a higher rate can count. Because VA pension income factors into any patient liability, talk to a benefits counselor who knows both programs before filing for either.6

Long-Term Care Insurance and the Tennessee Partnership

If your family member bought a long-term care insurance policy years ago, dig it out now and read the benefit triggers, the daily or monthly maximum, and the waiting period before you need them. A policy pays only once a benefit trigger is met, most often needing help with two or more of six activities of daily living or having a cognitive impairment, as judged by the insurer's own assessment. Payment then starts after an elimination period the buyer chose, usually 30, 60, or 90 days, and the family pays for any care during that wait.9

Tennessee adds something worth knowing about: Tennessee Partnership policies. A Partnership policy links private long-term care insurance to extra TennCare asset protection. For every dollar a qualified Partnership policy pays out in benefits, one dollar of assets is not counted toward the Medicaid resource limit.6

The catch is timing. The protection builds only as the policy pays benefits, so this is mainly a tool for people who bought coverage well before they needed care. If your family member already holds a Partnership policy, treat it as one of the most valuable assets in their plan, because it does double duty: it pays for care now and protects savings later.

Other Ways to Pay for Senior Care in Tennessee

A few smaller levers can stretch the main sources further. Use them as supplements, not as a plan on their own:

• Help with Medicare costs. Tennessee's Medicare Savings Programs, run through TennCare, pay the Medicare Part B premium (and, for Qualified Medicare Beneficiaries, deductibles and coinsurance too) for people with limited income and resources, which frees up money for care.15 See our guide to Tennessee's Medicare Savings Programs.
• PACE. The Program of All-Inclusive Care for the Elderly is a TennCare benefit for people 55 and older who need a nursing-home level of care but can live safely in the community, and most participants have both Medicare and TennCare. In Tennessee it is open only to people who live in Hamilton County, through Alexian PACE in Chattanooga.16
• Family contribution and caregiver pay. Family members can share costs, and through CHOICES Consumer Direction a member can hire family members as their paid home care workers, though not a spouse, and not a family member who also acts as the member's representative.17 See our guide to getting paid as a family caregiver in Tennessee.

Two things to be careful with: avoid moving assets just to qualify for TennCare without advice, because of the look-back penalty, and be skeptical of anyone selling annuities or trusts as a guaranteed Medicaid fix. When the stakes are your parent's care and your family's money, it's worth talking to an elder-law attorney before making a big move.

Learn More

Find personalized help paying for senior care in Tennessee 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.