Who Pays for a Nursing Home if You Have No Money? Care Options, Costs, and Resources

Medicare won’t cover long-term nursing home stays, but it can be used for short-term skilled nursing care after an injury or illness. Medicare Part A, also known as Hospital Insurance, will cover a rehabilitative stay and rehabilitative services in a nursing home for up to 100 days. However, starting on day 21, a senior is responsible for paying coinsurance of $209.50 per day.^[01] Medicare may also cover hospice stays, as determined by a doctor.

To qualify for 100 days of care in a nursing home under Medicare, even with a copay, a senior must:

• Have Medicare Part A and have days left in their benefit period to use
• Have been discharged from a three-day or longer inpatient stay in a hospital
• Possess a doctor’s prescription for skilled nursing care, per Medicare’s guidelines
• Select a Medicare-certified skilled nursing facility
• Require care specifically related to either the medical condition treated during their qualifying hospital stay or related to a separate condition that began during their nursing home stay
• Need skilled nursing care or therapy to maintain their current condition, or to prevent or delay it from getting worse

After day 100, Medicare’s coverage of nursing home care stops. If your loved one needs to stay in the nursing home longer, whether they choose to reside there long term or they simply require more rehabilitation, they’ll have to rely on other resources to pay for care.^[01]

What does Medicare cover?

Even after 100 days, Medicare may still cover some aspects of your loved one’s nursing home care. For example, Medicare may pay for medically necessary physical, occupational, or speech therapy, wound care, or injections, but it won’t pay for long-term assistance with activities of daily living (ADLs), monthly rent, or amenity fees.^[01]

Unlike Medicare, Medicaid pays for long-term nursing home care for all seniors who meet program requirements. Medicaid is the primary source of nursing home coverage in the country, covering 63% percent of nursing home residents in 2024.^[02]

However, Medicaid eligibility criteria vary by state. When a senior applies for Medicaid nursing home coverage, representatives will analyze their medical needs, income, assets, and five-year spending history to determine if they’re eligible for the program. If a senior is approved for Medicaid, they’ll pay an income-based coinsurance amount to secure care. Medicaid will then cover the majority of nursing home costs.

What does Medicaid cover?

Federal requirements state that eligible Medicaid recipients won’t be charged for the following in nursing homes:^[03]

• Nursing and related services
• Treatments for mental illness, intellectual disability, or cognitive decline
• Medically related therapies, like physical and occupational therapy
• Pharmaceutical services and medication management
• Meals
• Activities offered by the nursing home that are designed to provide stimulation and socialization for patients
• Emergency dental services
• Standard housekeeping and room maintenance
• Assistance with ADLs
• Personal hygiene items and services

Seniors with Medicaid may have to pay extra for the following items and services in a nursing home:

• A private room that isn’t medically necessary
• Activities separate from those on a standard social calendar
• Special meals based on dietary preferences or religion, such as vegan, kosher, or gluten-free meals
• A television
• A telephone

Read more:Medicaid Long-Term Care: What Is It and What’s Covered?

Can you afford senior living?

The U.S. Department of Veterans Affairs (VA) provides a mix of VA benefits to help qualifying veterans and their families pay for nursing home care.

Wartime veterans and their surviving spouses may qualify for financial benefits through the following pension programs:

• Veterans Pension and Survivors Pension. Veterans and their surviving spouses must meet specific criteria to qualify for the Veterans Pension and Survivors Pension, respectively.^[04,05]
• VA Aid and Attendance benefit. TheAid and Attendance benefit is added to the Veterans Pension or Survivors Pension to help recipients pay for their care needs. There are additional clinical requirements that a veteran or their surviving spouse must meet to receive this benefit.^[06]

Additionally, the Veterans Health Administration covers nursing home care for veterans who are enrolled in VA health care, demonstrate a medical need, and live near a VA-approved facility. Income and service-connected disability criteria may also apply.^[07]

What do VA benefits cover?

VA pension funds can be used however a recipient chooses, but Aid and Attendance benefits are intended to help pay for long-term care services and supports provided at home or in a senior living community like a nursing home.

When it comes to VA health care coverage of nursing homes, there are three kinds of VA facilities:

• Community Living Centers
• Community Nursing Homes
• State Veterans Homes

Although each of these options serves slightly different needs, all three can provide skilled nursing care, round-the-clock supervision, and ADL assistance.^[08]

Read more:A Guide to VA Nursing Homes: Types, Eligibility Requirements, and Costs

Seniors can use their Social Security benefits to help pay for nursing home costs, although they’re unlikely to cover the full amount. According to research conducted by the Center on Budget and Policy Priorities, “[Social Security] is the largest single source of income for older adults, providing the majority of income for half of retirees and at least 90 percent of income for 18 percent of retirees.”^[09]

While most of the other programs listed above pay for specific medical and custodial care needs, seniors can use Social Security funds at their own discretion. Several factors, including state of residence, age, work history, and past earnings can affect a person’s Social Security benefits. The Social Security Administration (SSA) offers three main types of benefits:

• Social Security retirement benefits: Retirement benefits are based on a person’s work history, or their current or former spouse’s work history. The average monthly Social Security retirement benefit is $1,981.^[10]
• Social Security Disability Insurance (SSDI): SSDI provides monthly payments to individuals who have a long-term disability or terminal condition that prevents them from working. The average monthly SSDI payment is $1,581.^[10]
• Supplemental Security Income (SSI) benefits: SSI is for low-income adults who are disabled, blind, or age 65 or older. The average monthly SSI benefit for seniors is $591.^[10]

What does Social Security cover?

Does Social Security pay for nursing home stays? Not directly. Social Security benefits are directly deposited into a recipient’s bank account, so they can use that money to cover nursing home care or any other care needs.

The median cost of a private room in a nursing home is $10,646 a month, while a semi-private room costs about $9,277 a month.^[11] Generally, nursing homes are the most expensive type of senior living because they provide the highest level of care and supervision.

Expert advice for affordable senior living

A nursing home may be the best option for a loved one with limited resources, but it depends on the type of care they need. Here’s a breakdown of other senior living options and how the resources listed above can help your family pay:

• Assisted living communities help seniors with minor physical limitations remain independent and active. These communities provide help with ADLs, scheduled activities, social opportunities, meals, and light housekeeping. Many of the ways to pay for assisted living with no money are the same as those listed above, with the key exception of Medicaid, which does not cover room and board.
• Memory care communities are supportive, residential settings that cater to seniors with Alzheimer’s disease and other types of dementia. Because they can be stand-alone or a designated wing in an assisted living community, Medicare and Medicaid will pay for a resident’s medical needs in the same way they pay for a person residing at home. However, there are limited benefits to pay for the room and board aspects of memory care unless the facility is designated as a nursing facility.
• Hospice care is an option if your loved one has been diagnosed with a terminal illness, a doctor has estimated that they have a life expectancy of six months or less, and they decline further curative treatment. Since hospice care is covered by most types of insurance, including Medicare, Medicaid, and VA health care, out-of-pocket costs for seniors and their families tend to be minor. Hospice can be provided wherever a senior calls home. Medicare and the VA may also cover hospice care in an inpatient facility if a patient’s family caregivers need a break or if their symptoms can’t be managed in other settings.^[12,13]
• The department of Housing and Urban Development (HUD) doesn’t pay for nursing homes, but it can help lower-income seniors secure housing and care through rental assistance programs. The Housing Choice Voucher Program (formerly Section 8) and Section 202 let seniors choose from different government housing options that best fit their needs.
• Aging at home or living with family members can be a viable option, depending on the level of care your loved one needs. Veterans may qualify for the pension benefits described above, or Home Based Primary Care, which offers in-home support for ongoing medical conditions and ADL assistance. Additionally, many states offer Medicaid programs that can help pay for home care, home health care, and other home- and community-based care services (HCBS).

The table below shows how various payment options can help cover different types of senior care.

If your loved one needs care as they age, it’s helpful to plan ahead as much as possible. Consider your family’s budget. Does your relative have any savings or receive regular pension payments? Do they have assets like a home, stocks, or bonds that could be sold to pay for care?

Next, think about the payment options above that may be available to your loved one. They may qualify Medicaid based on their financial situation. If your relative is a veteran, or the surviving spouse of a veteran, they can apply for VA benefits.

If you aren’t sure where to start, reach out to one of A Place for Mom’s Senior Living Advisors. They can help you explore different senior care options, learn about your family’s budget, and offer more information about the programs above, all at no cost to you.