How to Pay for Assisted Living and Long-Term Care

Medicare does not pay for assisted living or long-term care. Families cover the cost one of four ways: paying privately, Medicaid, VA benefits, or long-term care insurance. Which one fits depends on income, assets, and whether your loved one served in the military.

What a private room costs in a nursing home

Worth knowing before you ask for one. In skilled nursing, a private room is roughly double a shared one — the difference between about $10,000–$12,000 a month and $20,000–$24,000.

Availability is its own problem. Most communities will give you a private room if they have one, but when a building fills up, semi-private is often all there is. It is a question to ask on the day you are deciding, not a box to tick weeks earlier — the answer changes.

Respite is not the same as hospice respite

Two different things share the word, and families mix them up constantly.

Respite in assisted living is a short stay so a caregiver can rest, or so a family can try a community before committing. It is private pay, usually charged per day, and it depends on a room being free.

Hospice respite is a Medicare benefit. It covers a short inpatient stay, and it happens in a skilled nursing facility, not in assisted living. If someone is on hospice, ask their hospice team about it — it is part of the benefit they already have, and it is frequently unused.

Why Medicare won't cover it

Medicare is health insurance. It pays for doctor visits, hospital stays, medicine, and short-term rehab after something like a hip fracture or a bad case of pneumonia. Assisted living and long-term care are different: they're meant to be someone's home for years, not weeks, and Medicare doesn't pay rent anywhere, including at a facility. Read the full breakdown of what Medicare does and doesn't cover.

The 4 ways families pay

1. Private pay

Paying out of pocket is the most common way families cover assisted living and long-term care. Cost depends on the region, the room, and how much help someone needs.

2. Medicaid

Medicaid can cover part or all of the cost for families with limited income and assets, but the rules differ by the type of care. For assisted living, Utah's New Choices Waiver pays part of the monthly cost; read how the waiver works. For a nursing home, coverage kicks in once a person meets Utah's "10A" level-of-care rules; read what 10A requires. Both programs look back 5 years at money that was given away, and both protect a spouse who stays at home.

3. VA benefits

Veterans, their spouses, and surviving spouses may qualify for a benefit called Aid and Attendance, which helps pay for assisted living. The VA also pays for long-term care when a veteran is on hospice, through a faster, separate application. Help filing a claim is always free. Read how VA benefits work.

4. Long-term care insurance

This is its own insurance product, usually bought years in advance, not part of Medicare or a health plan. Most facilities still expect payment out of pocket first; you then send your receipts to the insurance company for reimbursement, typically about a month behind. If your family holds one of these policies, plan for that delay.

Where do I start?

1. Find out what level of care your loved one needs. Take the Care Finder.
2. List monthly income and assets. Social Security, pensions, savings, a house, a car. Then take the Utah Medicaid quiz to see which programs may be worth a look.
3. Check veteran status. If your loved one served, or is the spouse of someone who did, call a Veterans Service Officer.
4. Get advice before moving money. Talk to an elder law attorney before giving away or spending assets. Medicaid's look-back can delay coverage otherwise.
5. Ask every facility two questions. "Do you accept the New Choices Waiver?" and "What would our monthly share be?"
6. Loop in the people who do this daily. Hospital and rehab social workers, hospice teams, and your local Area Agency on Aging help families with this every day.

What about hospice or palliative care costs?

Those are covered separately from assisted living or memory care itself. Hospice is paid for by the Medicare Hospice Benefit, Medicaid, VA benefits, and most private insurance, usually with little to no out-of-pocket cost, though it doesn't cover a facility's room and board. Palliative care is billed like a specialist visit, with the usual Medicare Part B copays. See our guide to hospice or palliative care for the full comparison.