Does Social Security Pay for Nursing Home Care?
Navigate the complexities of nursing home care funding. Discover which programs and resources truly cover these substantial long-term costs.
Nursing home care presents a significant financial challenge. With average monthly expenses reaching thousands of dollars, understanding how these costs can be covered is a common concern. Various funding mechanisms exist, each with specific limitations.
Social Security’s Role in Nursing Home Expenses
Social Security benefits (retirement, SSDI, and SSI) provide income that can be directed towards nursing home costs. However, these monthly payments typically fall far short of covering the total expense. For instance, a semi-private nursing home room averages around $9,277 per month, and a private room averages about $10,646 per month in 2025. An average Social Security retirement benefit, at approximately $1,979 per month in 2025, would cover only a fraction of these charges.
Social Security payments are generally sent directly to the individual. A designated representative payee, such as a nursing home with proper consent, can manage these funds. Supplemental Security Income (SSI) benefits may be reduced to a small personal needs allowance if Medicaid pays for a nursing home stay exceeding 90 days. However, Social Security retirement or SSDI benefits are not typically reduced during a nursing home stay if the individual is not also receiving Medicaid.
Medicare Coverage for Nursing Home Care
Medicare covers skilled nursing facility (SNF) care under specific, limited circumstances. This coverage differs from the long-term, non-medical care often associated with nursing homes. Medicare generally covers short-term skilled care for recovery, not ongoing assistance with daily activities (custodial care).
To qualify for Medicare SNF coverage, an individual must have had a medically necessary inpatient hospital stay of at least three consecutive days. Admission to a Medicare-certified SNF must occur within approximately 30 days of this hospital stay. The patient must require daily skilled nursing or therapy services, such as physical therapy or intravenous injections, to improve, maintain, or prevent decline.
Medicare Part A covers the full cost for the first 20 days of a qualifying SNF stay within a benefit period. For days 21 through 100, a daily co-insurance amount applies, which is $209.50 per day in 2025. Beyond 100 days in a benefit period, Medicare does not cover SNF costs, making it unsuitable for prolonged nursing home needs.
Medicaid as a Primary Payer for Long-Term Care
Medicaid stands as the primary government program assisting with the costs of long-term nursing home care for individuals who meet specific financial and medical criteria. Unlike Medicare, Medicaid can cover ongoing custodial care, including room, board, personal care, and skilled nursing services, for eligible residents. This program is jointly funded by federal and state governments, with specific eligibility rules varying by state, yet common generalities exist nationwide.
Eligibility for Medicaid nursing home coverage typically involves meeting strict income and asset limits. For instance, in 2025, an individual applicant might need to have monthly income below approximately $2,901 and countable assets under $2,000. Additionally, a medical assessment must determine that the individual requires a “nursing home level of care,” indicating a need for the services provided in such a facility. If an individual’s income or assets exceed the state’s limits, a “spend down” process may be available. This allows individuals to reduce their countable resources by incurring medical expenses, effectively lowering their financial standing to meet Medicaid’s thresholds.
Once qualified, Medicaid generally covers 100% of the approved nursing home costs. However, the nursing home resident is typically required to contribute nearly all of their monthly income towards their care, with the state Medicaid program paying the remaining balance. Residents are usually permitted to retain a small monthly personal needs allowance, which can vary by state, for incidental expenses.
Other Avenues for Funding Nursing Home Care
Beyond government programs, several other options exist for funding nursing home care. Private payment involves using personal resources such as savings, investments, and pensions. Given the high monthly costs, ranging from over $9,000 to $10,000, private funds can deplete quickly, making this a short-term solution for many.
Long-term care insurance offers a means to cover nursing home expenses, among other services, when an individual requires assistance with daily living activities due to a chronic condition or cognitive impairment. These policies typically cover room and board, skilled nursing care, and personal care, providing a financial safety net for long-term needs.
Veterans’ benefits, specifically the Aid and Attendance Pension, can also provide financial assistance. This benefit is available to eligible wartime veterans and their surviving spouses who require the assistance of another person for daily activities or are housebound, including those residing in nursing homes. These funds are paid in addition to a basic pension and can help offset the considerable costs of care.