What the United States Pays For, and What It Leaves to Families
Wanda is the one who lives nearest. She sat down with a list of programs and asked which of them would pay.
Picture a woman named Wanda, 77. Her brother is 84, a veteran, and has begun to need help with bathing and meals. Wanda is the one who lives nearest. She sat down with a list of programs and asked which of them would pay.
"Medicare," she said.
Her brother read the website aloud. "It says Medicare does not cover custodial care if that is the only care you need."
"What is custodial?"
"Help with basic daily tasks, like bathing."
Wanda wrote that down. Then she went through the rest of the list.
| Payer | What it pays for | What it leaves out |
|---|---|---|
| Medicare | Short-term skilled nursing or rehabilitation, up to 100 days, after a hospital stay of at least three days. In 2026 days 21 to 100 cost US$217 a day | Long-term custodial care when it is the only care needed |
| Medicaid | The main payer for over 60% of nursing home residents (KFF, 2025). Home and community waivers pay for services such as personal care and respite | Room and board in assisted living. About 17% of assisted living residents had some services paid by Medicaid in 2022 |
| Veterans Aid and Attendance | An extra monthly amount on a veteran's pension: US$2,424 for a single veteran, US$2,874 with a spouse, from 1 December 2025 | Veterans who do not meet the program's rules |
| Long-term care insurance | Usually starts when a person cannot do 2 of 6 daily activities, or has cognitive impairment, after a wait of 30, 60 or 90 days | Care during the wait, and anyone without a policy |
Medicaid is run by the states. Federal law looks back 60 months at gifts of assets when a person applies for nursing facility coverage. Each state sets its own limits on income and savings, and the state Medicaid office can say what they are.
Her brother had not looked into the veterans benefit. Wanda found the Department of Veterans Affairs page. It says the benefit applies to a veteran who needs help with daily tasks, is bedridden, is in a nursing home, or has severely limited eyesight. The page gives no net-worth limit and does not mention assisted living. Ask the office, or a paid professional.
For scale, the 2025 CareScout survey put the national median for assisted living at US$6,200 a month. Medicare does not pay it, and Medicaid does not pay room and board.
"So the family covers the rest," Wanda said.
An AARP study in 2025 estimated that about 63 million Americans are family caregivers, 59 million of them for an adult. The average out of pocket was US$7,200 a year.
You could…
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Ask the Department of Veterans Affairs whether a veteran in the family could qualify for Aid and Attendance.
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Ask an insurance agent what a long-term care policy would cost at your age, and what starts the benefit.
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Ask the state Medicaid office how it treats a home and savings.
What did you find out about who pays, and when? Share it here. Someone reading may have the same list on the kitchen table.
Figures are estimates for planning, based on public data. Sources: Medicare.gov (long-term care; skilled nursing facility care); KFF (28 May 2025); NCHS Data Brief 506; Medicaid.gov; VA.gov (rates effective 1 December 2025); Administration for Community Living; CareScout Cost of Care Survey 2025; AARP and National Alliance for Caregiving (24 July 2025); 42 U.S.C. 1396p.
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