Once someone turns 65, there’s about a 70% chance they’ll need some form of long-term care at some point, according to LongTermCare.gov.
Paying for that care can be challenging. Genworth’s Cost of Care Survey reports that in 2024, the median cost of a semi-private room in a U.S. nursing home was $111,325 per year.
So what happens if your parent ends up needing care your insurance won’t cover? Imagine your 80-year-old mother spent a month in the hospital and then was transferred to a skilled nursing facility because she can’t manage on her own. Her insurance denies payment, claiming she doesn’t need care. The nursing home then threatens to take her Social Security and pension checks to cover the bills.
Can they do that? And what about her other expenses, debts, or maintaining her home after leaving the facility? Here’s what you should know.
Can a Nursing Home Take Your Money?
Most likely, your mother’s primary coverage is Medicare, which serves most Americans over 65. If she has a Medicare Advantage Plan, it’s administered by a private insurer and must provide at least the same coverage as Medicare.
It’s important to know: Medicare does not cover routine nursing care (called custodial care) for people who can’t perform basic life tasks. It only covers skilled nursing care for up to 100 days under very specific circumstances, like immediately after a hospital stay.
Since your mother recently left the hospital, you may want to appeal Medicare’s denial. If her doctor supports the need for skilled care, they may help you file an appeal. Medicare offers guidance on appealing denials to try to get coverage.
If the appeal fails, your mother becomes a private-pay patient. She won’t have her benefits seized, but she will be billed for the nursing home and must pay to keep her place. Nursing homes usually require advance payment. If she can’t pay, the facility may ask her to leave, provided she’s not actively applying for Medicare or Medicaid.
How Medicaid Fits In
Medicaid can cover nursing care, but your mother must qualify. That generally means she cannot have more than $2,000 in countable assets. Once enrolled, her Social Security checks go to the nursing home—minus a personal-needs allowance (PNA) and any insurance premiums.
The PNA is currently set by federal rules at $30 per month, though states can set higher amounts—up to $200. Nationwide in 2024, the average PNA was $70.
So if your mother’s appeal is unsuccessful and she needs to stay in a nursing home, the facility may take almost all her income.
What Can You Do?
The best way to avoid these challenges is to plan ahead, ideally with long-term care insurance. The National Association of Insurance Commissioners provides guidance for finding a policy that fits your needs.
If your mother doesn’t have coverage, options are limited. You can reach out to creditors, including mortgage companies, to see if they’ll temporarily suspend payments. If possible, you could cover those bills yourself.
If your goal is to qualify for Medicaid while keeping her home, you’ll need to create an “intent to return home” document. Be careful about giving too much financial support, as it could push her above Medicaid’s $2,000 asset limit. Her primary home doesn’t count as a disqualifying asset, but if she’s living in a nursing home, it may no longer be considered her primary residence for Medicaid purposes.
It’s also important to note that Medicaid rules don’t provide exceptions for ongoing homeownership costs, such as property taxes and insurance.
Professional Help
Consulting an elder law attorney can help you appeal Medicare denials and protect your mother’s assets. Planning for nursing home care is most effective when started well before it’s needed.
If her benefits are sufficient to cover the nursing home, and if her other debts can be put into forbearance, this may be the best temporary solution. If she can’t afford the fees, exploring home health aide options could be another route.
