Long-term care, which can include everything from homemaker services and help from a home health aide to nursing home care, is expensive. In fact, the median monthly cost of a private room in an American nursing home is estimated to be $9,584 in 2023, according to GenWorth, an insurance company that offers long-term care coverage. Those costs are expected to increase to nearly $13,000 per month by 2033.
That’s well beyond what most people can afford from their retirement income, and many times what Social Security pays. That’s why it’s important to plan ahead, says Alec F. Root, a chartered financial analyst (CFA) with DBR & Co.
“As with estate planning in general, it is helpful to have these conversations sooner rather than later, especially before one’s health changes and potentially impacts their ability to properly insure themselves,” he told SmartAsset. “Five to 10 years prior to retirement is generally a good time to discuss this subject. A strong estate plan will detail the terms of late-life care, while a good financial plan will account for nursing home care and final expenses.”
Medicare won’t cover the costs of a nursing home or other facilities. Instead, generally, the best way to afford long-term care may be through dedicated long-term care insurance. The earlier you purchase this coverage the less expensive this will be. For a healthy 55-year-old, you can expect to pay between $950 and $1,500 per year for this coverage, according to the American Association of Long-Term Care Planning. At 65, those averages jump to between $1,700 and $2,700 per year. So prepare ahead of time.
Remember, a financial advisor can walk you through your options for paying for long-term care and potentially even help you purchase an insurance policy.
Medicaid Covers Long-Term Care But Has Asset Caps
A Medicaid recipient is wheeled through a nursing home.
If you can’t afford long-term care insurance, the next most common option is Medicaid – the government program that provides medical care for low-income households. While its coverage tends to be limited, it does pay for nursing homes, as well. However, it’s important to be aware that through the Medicaid Estate Recovery Program (MERP), it’s possible that someone’s assets may be recoverable by the government to repay nursing home expenses.
Medicaid also has strict income and asset caps, and every state has its own eligibility requirements and scope of coverage. For example, in New York, your income cannot exceed $1,677 per month and your total assets cannot exceed $30,182. However, the state does not count your IRA or Roth IRA toward those total assets.
Note: Medicare, the health care program for all Americans over 65, does not pay for long-term care facilities.
On the other hand, in Massachusetts, your income cannot exceed $1,215 per month and your total assets cannot exceed $2,000. There, the state does include your IRA among those total assets.
Keep in mind that if you have an IRA you’ll have to take required minimum distributions (RMDs) by age 73. These withdrawals will count toward your annual income cap. Roth IRAs, on the other hand, are not subject to RMDs but states may count the portfolio among your total assets, as Massachusetts does. But if you need help calculating your RMDs or managing your Roth assets, consider speaking with a financial advisor.
Trusts and Investments Can Offer Imperfect Protection
If your wealth exceeds these caps, you may have to spend almost all of it in order to qualify for coverage. Then again, there are ways to preserve your assets if you need Medicaid to cover your nursing home expenses.
“Traditional investments can be vulnerable to these financial threats, and that’s precisely why we need to explore alternative avenues,” said Dutch Mendenhall, CEO of RAD Diversified and author of Money Shackles.
You can move your money into assets that your state’s Medicaid program does not count against eligibility limits. Beyond a Roth IRA potentially shielding your assets from Medicaid, many households look to put their money in trusts. Doing so can reduce your on-paper wealth, making you potentially eligible for Medicaid coverage.
“Using a trust, such as an irrevocable trust, is a formidable weapon in your arsenal to shield your assets from the voracious appetite of long-term care costs,” said Mendenhall.
“Placing your assets in an irrevocable trust effectively removes them from your ownership, making them less susceptible to being counted as part of your financial assets during eligibility determinations for Medicaid, he added. “This separation can be a game-changer, potentially preserving your wealth.”
But only an irrevocable trust will work for Medicaid qualification. Assets in a revocable trust, meaning one that you can change or revoke while you’re still alive, still count toward your overall household wealth.
The typical vehicle for this is a form of irrevocable trust known as a Medicaid asset protection trust.
Be aware that there’s usually a ‘look-back’ period during which Medicaid considers your financial transactions leading up to your long-term care application. The assets you transfer into a trust may be subject to this scrutiny, so planning in advance is crucial. Most, if not all, states look back five years.
And if you need help establishing a trust or deciding what kind to set up, find a financial advisor with estate planning expertise.
Bottom Line
Long-term care insurance is one way to potentially pay for costly stays in nursing homes。This is a complicated answer to the complicated question of whether a nursing home can take your savings. While nursing homes can’t seize your assets, the costs of this care are high and can quickly drain your savings. Experts recommend preparing for these costs with diversified investments, income-generating assets and long-term care insurance. If that’s not an option, using a trust to qualify for Medicaid can be a potential avenue for getting coverage. But the specifics will range widely based on your personal situation, your assets and the state in which you live.
Medicaid Management Tips
While we didn’t have time to explore the topic fully here, some other options for protecting your assets from Medicaid can include annuities, life estates and even your own home.
A financial advisor can help you determine whether you could potentially qualify for Medicaid. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
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