How to Pay for Skilled Nursing Care: 5 Options You Might Not Know About
With the average skilled nursing facility costing $8,000–$12,000 per month, families often face a financial crisis. Most don’t realize:
- Medicare only covers short-term stays (20 days fully, days 21–100 require copays)
- Medicaid approval can take 6+ months
- VA Aid & Attendance benefits pay up to $2,500/month (but 60% of eligible veterans never apply)
Shocking Stat:
- 42% of seniors drain their life savings within 4 months of entering skilled nursing (Genworth Financial)
Families who plan use legal strategies to protect assets while qualifying for Medicaid—it’s not too late.
Key Rules:
Requires a 3-day inpatient hospital stay first
- Days 1–20: $0
- Days 21–100: $200/day copay
- Beyond 100 days: You pay 100%
Loophole:
- Some Medicare Advantage Plans offer extended skilled nursing facility (SNF) coverage.
Medicaid covers long-term skilled nursing, but you must:
- Spend down assets to $2,000 (varies by state)
- Protect your home (via homestead exemptions)
- Use "Miller Trusts" for income over limits
Pro Tip
Apply 6+ months early—backdated approvals are rare.
VA Aid & Attendance Benefit:
- Pays $1,936–$2,903/month for wartime veterans
- Covers widowed spouses, too
- No need for service-related injuries
Case Example: A Navy vet’s family used this to cover 65% of his dementia care costs.
If your loved one has a policy:
- Check elimination periods (e.g., 90-day wait)
- File appeals for denied claims (40% succeed)
- Use "shared care" riders for couples
Warning
New policies now exclude pre-existing dementia.
- Legal Ways to Qualify for Medicaid Faster:
- Promissory Notes (Convert cash to "loans")
- Annuities (Turn lump sums into income streams)
- Caregiver Agreements (Pay family members fairly)
We saved $300k by moving Mom’s assets into a Medicaid-compliant annuity 3 years early.
Red Flags in Facility Billing Practices
- "Extra fees" for basic care (e.g., toileting assistance)
- Pressure to private-pay first (may delay Medicaid approval)
- No clear cost breakdown
Yes! Medicaid can’t take your primary residence if a spouse lives there.
Some state Medicaid programs cover the $200/day gap.
Locate, consult and apply benefits
[Find Medicaid-Certified Facilities]
1
Consult an Elder Law Attorney (For asset protection)
2
Apply for VA Benefits (Takes 4–6 months)
3
Note
Need Immediate Help? Call your local Area Agency on Aging at 1-800-677-1116.
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