How do we pay for this?

Many families find this out in a hospital hallway, when someone mentions the word “discharge”. Medicare isn’t what many people think it is, and the bill for ongoing care can land on the family without warning. Here’s what each source really pays for.

What Medicare pays for, and what it doesn’t

The line to remember: Medicare pays for medical care, not for help with everyday life. Medicare says so directly: it doesn’t pay for long-term care, also called custodial care, which is help with things like dressing, bathing and using the bathroom.

If your parent needs	What Medicare does
Rehab or skilled nursing after a hospital stay	Pays for up to 100 days per benefit period, if they meet the rules below
Skilled care at home, part time	Pays, if they’re homebound and a doctor orders it
Hospice care	Pays for the care, but you may have to pay for room and board in a facility
24-hour care at home	Doesn’t pay
Meal delivery, shopping, cleaning	Doesn’t pay
Only help with bathing, dressing and daily tasks	Doesn’t pay
Assisted living	Doesn’t pay
A long-term stay in a nursing home	Doesn’t pay for the stay. It may still pay for some costs, like doctor visits

The rule that catches families out

To get skilled nursing coverage, your parent generally needs a hospital stay as an admitted inpatient for at least three days in a row. Time under “observation” or in the emergency room doesn’t count, even if they spent the night in a hospital bed.

So ask the hospital every day: “Is my mother admitted as an inpatient, or here under observation?” Medicare Advantage plans may have different rules, so ask the plan as well.

What 100 days really means

These are the 2026 amounts for Original Medicare. Medicare sets new ones each year.

Days in a skilled nursing facility	You pay
Days 1 to 20	$0 a day, after the $1,736 Part A deductible
Days 21 to 100	$217 a day
Day 101 on	All costs

And it isn’t a promise of 100 days. Coverage is only for as long as your parent needs daily skilled care. The government’s long-term care site puts the average covered stay at 22 days.

Medicaid

Medicaid is a joint federal and state program, and it pays the largest share of long-term care. It’s also where the rules get hard, because each state runs its own version. Your parent must have income below a set level, meet the state’s other rules, and need enough help with daily activities.

• Nursing homes. Medicaid’s nursing facility benefit includes room and board.
• Care at home. Medicaid also covers some care at home and in the community. What’s offered varies by state, so ask what’s available and whether there’s a waiting list.
• Assisted living. Medicaid may cover some of it, depending on the state. Outside a nursing home, Medicaid services can’t include room and board, so expect a bill for the rent even if the care is covered.

Three things to know before you apply

The five-year look-back. Medicaid looks back 60 months at money and property given away or sold for less than it’s worth. A gift to you, even a well-meant one, can delay coverage just when your parent needs it. Don’t move anything until you’ve had advice.

Protection for the spouse at home. If one parent needs nursing home care and the other stays home, federal rules protect part of their savings and income, so the spouse at home isn’t left with nothing.

Estate recovery. After someone 55 or older dies, states must try to recover what Medicaid spent on their nursing home and home care from their estate, which can include a home. States can’t do this while a spouse, a child under 21, or a blind or disabled child survives them, and they must have a process for waiving it in cases of hardship.

If your parent is a veteran

Many families never ask about this one. Look at two things:

• Aid and Attendance. This is a monthly payment added to a VA pension for veterans and survivors who need help with daily activities like bathing and dressing, spend much of the day in bed, live in a nursing home because of lost abilities, or have very limited eyesight. They must receive the pension first.
• VA long-term care. The VA covers long-term care for some veterans, at home or in a facility. There may be a waiting list for VA nursing homes.

An accredited representative can help with the claim. Help from a Veterans Service Organization representative is always free. Accredited attorneys and claims agents can charge fees.

PACE

PACE is a Medicare and Medicaid program that helps people who would otherwise need a nursing home keep living at home. It’s for people 55 or older who live in a PACE service area, need nursing-home-level care as certified by their state, and can live safely in the community with its help. It’s only available in some states. People with Medicaid pay no monthly premium, and people with Medicare only pay one.

Their own money

Most long-term care starts here: savings, pensions, investments, or the sale of a home.

• Find any long-term care insurance policy. Look through their papers before you need it, and read what starts the benefit and how long it lasts.
• Don’t count on ordinary health insurance. Most policies have limited, if any, long-term care benefits.
• Be careful with big financial products. Reverse mortgages, annuities and life insurance options each have their own rules and costs. Get independent advice before signing anything.

When the money runs out

This is one of the questions families ask most, and it’s better asked early.

1. Work out how long the money will last. Add up monthly income, savings and what care costs now, and do it before there’s a crisis.
2. Before a move, ask the facility: Do you accept Medicaid? What happens to my mother if her savings run out? Would she have to change rooms? Get the answers in writing.
3. Ask about Medicaid before the last dollar is gone. Your state Medicaid office can tell you the income and asset limits, and how long applications take.
4. Get professional help if your parent has a house or significant savings. An elder law attorney can explain your state’s rules. Ask what a single consultation costs.

What to do this week

1. Find out what’s in place: Medicare card and any supplement or Advantage plan, Medicaid, veteran status, long-term care insurance.
2. Call your SHIP counselor for free, unbiased help with Medicare and Medicaid: 877-839-2675. Open enrollment is busy, so call early.
3. Call the Eldercare Locator at 800-677-1116 and ask about local help and paying for care.
4. If your parent served, ask about Aid and Attendance.
5. Don’t sign over money or property yet, and put a power of attorney on the list.