Paying for a nursing home: Medicare, Medicaid and protecting a spouse

What Medicare pays

Medicare pays for a stay in a skilled nursing facility, up to 100 days, only after a qualifying inpatient hospital stay of at least 3 days and only while skilled care is needed (see Leaving the hospital). Medicare does not cover custodial care, meaning help with bathing, dressing, eating and using the bathroom, when that is the only care needed. Most long-term nursing home stays are custodial.

Medicaid for nursing home care

Every state Medicaid program must cover nursing facility care for people 21 and older who need it and qualify. Medicaid pays only when other ways to pay are not available.

• Need for care: each state sets its own "level of care" rules for who needs a nursing home.
• Income and savings: each state sets its limits. Some states use higher income limits for nursing home residents than for other Medicaid.
• Your parent's income: most of it goes toward the cost of care. Your parent keeps a small personal needs allowance for their own use. The federal minimum is $30 a month; states can set more.

Apply through your state Medicaid agency. Your state guide has the name of the program and how to apply.

Protecting the spouse at home

When one spouse needs nursing home care and the other stays at home, federal "spousal impoverishment" rules protect the spouse at home. For 2026:

Each state picks the amounts it uses within these limits. If the spouse at home has less income than the allowance, part of the nursing home spouse's income can go to them. Alaska and Hawaii have higher minimum income allowances.

The home: a person may not qualify for Medicaid long-term care if their equity in their home is above the state's limit, which must be between $752,000 and $1,130,000. Ask your state about its limit and any exceptions.

The 5-year look-back on gifts

When your parent applies, Medicaid looks at money and property given away or sold for less than its value in the 60 months before applying. A gift in that time leads to a period when Medicaid will not pay for nursing home care.

The length of that period is the total value given away divided by the average monthly cost of private nursing home care in the state. For example, if the average cost is $10,000 a month and $50,000 was given away, Medicaid would not pay for 5 months.

Do not move money or property to qualify without advice from an elder law attorney or your state's legal aid for older adults.

Estate recovery

For people who got Medicaid at age 55 or older, states must try to recover what Medicaid paid for nursing home care, home and community-based services, and related hospital and drug costs, from the person's estate after death.

• States may not recover while there is a surviving spouse, a child under 21, or a child of any age who is blind or has a disability.
• States must have a way to waive recovery when it would cause undue hardship.

Choosing a nursing home

• Care Compare: Medicare's Care Compare gives each nursing home a rating from 1 to 5 stars, with separate ratings for health inspections, staffing and quality.
• Long-Term Care Ombudsman: every state has an ombudsman office that helps residents and families resolve complaints and speaks up for residents' interests. It is free. Find yours at theconsumervoice.org/get_help or through the Eldercare Locator, 1-800-677-1116.

Other ways to pay

• Veterans: VA Aid and Attendance adds a monthly amount to a VA pension for people who need help with daily activities. See Paid family caregiving.
• Care at home instead: ask the state Medicaid agency about home and community-based services, which pay for some care at home or in the community.

Related guides

• Leaving the hospital: Medicare rights and next steps
• Can I get paid to care for a parent?
• Medicare Part A (hospital insurance)

Check what you may qualify for