Most people assume Medicare covers nursing home care. It doesn't. Learn what Medicare actually pays for and how families are covering long-term care costs in 2026.
7 out of 10 people turning 65 today will need long-term care at some point.
And here's the catch: Medicare doesn't cover it.
Most families assume that once someone turns 65 and gets on Medicare, they're set for whatever care they might need. Then a fall happens, or a dementia diagnosis comes, and suddenly they're looking at $16,000 a month for a nursing home—with no Medicare help.
Let's clear up what Medicare actually covers, and then talk about how families are paying for care.
What Medicare Does (and Doesn't) Cover
Medicare pays for medical treatment and short-term recovery. It doesn't pay for ongoing help with daily life.
Medicare covers things like:
Doctor visits and hospital stays
Physical therapy after surgery
Wound care or IV medications
Short-term rehabilitation to recover from an illness or injury
Medicare doesn't cover:
Help with bathing, dressing, or getting out of bed
Assistance with eating or using the bathroom
Someone to supervise a person with dementia
Ongoing support when recovery isn't the goal
That second list—what Medicare doesn't cover—is what long-term care actually is. And it's what most people eventually need.
The Medicare "100-Day Cliff"
Medicare Part A will pay for a nursing facility stay, but only under strict conditions and only for 100 days maximum.
To qualify, you need a 3-day hospital stay first (as an admitted patient, not just under observation), and you need to go to the facility within 30 days of leaving the hospital.
Here's what you'll pay in 2026:
Days in Facility | Your Cost |
Days 1-20 | $0 (after $1,736 deductible) |
Days 21-100 | $217 per day |
Day 101 onward | Everything |
If you use all 100 days, you'll pay $17,360 out of pocket before Medicare stops entirely. And on day 101, you're on your own—paying the full daily rate, which in California averages around $535 per day for a private room.
That's where the real problem starts.
What Long-Term Care Actually Costs
In California right now, here's what families are facing:
Nursing home (private room): About $16,100 per month
Assisted living: Around $5,500-$7,000 per month
Full-time in-home care: $8,000-$12,000 per month
And these aren't short-term expenses. The average nursing home stay is 2.5 years. Many people stay much longer.
Common Situations That Lead to Needing Care
Long-term care needs often arise suddenly. The most common triggers we see:
A fall that leads to hospitalization and recovery that never quite gets back to independent living
A stroke that leaves someone needing ongoing assistance with daily activities
Dementia diagnosis where someone can no longer safely live alone
Progressive conditions like Parkinson's or multiple sclerosis that gradually reduce independence
Understanding these patterns helps families recognize when to start having conversations about care options, rather than being caught completely off guard.
Protect your family’s hard earned savings and get peace of mind — starting today.
How Families Are Actually Paying for This
Since Medicare doesn't help beyond those first 100 days, here's what we're seeing families do:
1. Use Their Savings First
Most people start by paying out of their own pocket. This works until the money runs out—which happens faster than most people expect.
The numbers: For people who enter nursing homes using their savings, about 16% run through their assets within the first year. On average, it takes about 6 months to burn through savings. For longer stays (4 years or more), nearly 62% of people who started by paying themselves eventually need government help.
2. Switch to Medi-Cal
Note: Medi-Cal is California's Medicaid program. If you're reading this from another state, the same principles apply—Medicaid is the government program that covers long-term care nationwide, though rules vary by state.
Medi-Cal covers long-term care for people with limited assets. Right now, about 61% of California nursing home residents rely on it.
To qualify in 2026, you need to have less than $130,000 in countable assets ($195,000 for couples). (Read more about the 2026 Medi-Cal changes.)
Many families work with elder law attorneys to strategically convert countable assets (like cash) into exempt ones (like home repairs, a car, or prepaid funeral costs) so they can qualify for coverage while preserving value for the family. (Learn more about how California determines Medi-Cal qualification.)
3. Use Home Equity
Many families use reverse mortgages to access the value of their home without selling it. This can fund in-home care, allowing someone to stay in their house rather than move to a facility.
The loan doesn't need to be repaid until the home is sold or the homeowner passes away.
4. Long-Term Care Insurance
Traditional long-term care insurance still exists, but premiums have gotten expensive and many carriers have left the market.
As an alternative, more families are choosing "hybrid" policies—life insurance with a long-term care rider. If you need care, you use your death benefit while you're alive. If you never need care, your family gets the life insurance payout.
People prefer hybrids because you don't lose your money if you stay healthy, which was the issue with traditional policies where you paid premiums for years and got nothing back if you never filed a claim.
5. Tap Into VA Benefits
If you or your spouse served in the military during wartime, you might qualify for VA Aid & Attendance—a monthly benefit specifically for care costs.
In 2026, this can be up to:
$2,424/month for a single veteran
$2,874/month for a veteran with a spouse
$1,558/month for a surviving spouse
It won't cover the full cost of a nursing home, but it helps, especially for in-home care or assisted living.
When to Start Planning (And What Happens If You Don't)
The families who manage this best start planning before there's a crisis. Ideally, start having conversations in your early 60s, or when parents reach 70—before health issues force rushed decisions.
Waiting until someone's in the hospital means making decisions under pressure with limited options. You might miss out on strategies that could have preserved assets, or find yourself scrambling to qualify for programs that require advance planning.
Planning ahead means understanding what things actually cost, knowing what you might qualify for (VA benefits, Medicaid, etc.), and having time to make strategic decisions instead of emergency ones.
Elder law attorneys help families work through these questions early. They can show you what funding sources you might have access to, help structure things to preserve value, and create a realistic plan.
How Almer Helps
We connect families with elder law attorneys who specialize in long-term care planning and Medicaid. These attorneys know the rules, understand VA benefits, and can help you create a plan before you need it urgently.
We match you with the right attorney for your situation and stay with you through the process. You'll know what questions to ask and what options you have. You handle your family—we handle everything else.
Long-term care costs are real and substantial, but with planning and the right support, they're manageable.
FAQs About Paying for Long-Term Care
Does Medicare pay for nursing home care?
Only for up to 100 days following a hospital stay, and only if you need medical care like physical therapy. It doesn't cover long-term stays or help with daily activities.
What do you do when the money runs out?
Most families transition to Medicaid (called Medi-Cal in California). About 61% of nursing home residents in California use Medi-Cal to pay for care.
When should I start planning for long-term care?
Ideally in your early 60s, or when parents reach 70. Starting before a health crisis gives you more options and time to make strategic decisions.
Disclaimer: This article provides general information and is not legal or financial advice. Every situation is different. For guidance specific to your family’s situation, consult with a qualified elder law attorney.
Almer connects families with elder law attorneys who specialize in long-term care planning and Medicaid. If you'd like to talk through your situation, we're here to help.
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Almer makes estate planning and long-term care planning easier by matching you with a vetted elder law attorney and guiding you step by step from intake to signed plan - so you’re never navigating this alone.
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