Nursing home costs can exceed $100,000 per year. Understanding every payment option — and in what order to use them — can protect your family’s finances while ensuring your loved one gets the care they need.
The Payment Waterfall: How Most Families Actually Pay
Most nursing home stays follow a predictable financial progression:
- Step 1 — Medicare: Covers skilled nursing care for up to 100 days after a qualifying hospital stay. Free for days 1–20; $194.50/day co-pay for days 21–100.
- Step 2 — Private pay / savings: Once Medicare ends, most families pay out of pocket while spending down assets to Medicaid eligibility.
- Step 3 — Medicaid: When assets reach $2,000 (Missouri limit), Medicaid covers long-term care indefinitely.
Medicare
Medicare Part A covers skilled nursing facility care — but only after a 3-day qualifying hospital inpatient stay and only for care that requires skilled nursing or therapy. Coverage ends when skilled care needs end, even before day 100. Full Medicare guide →
Medicaid (Missouri MO HealthNet)
Medicaid is the primary payer for long-term nursing home care. Missouri’s Medicaid program requires assets below $2,000 for a single person. An elder law attorney can help structure assets legally to qualify. Full Medicaid guide →
Long-Term Care Insurance
If purchased before a care need arises, long-term care insurance can pay $150–$300/day toward nursing home costs. Policies vary significantly in:
- Daily/monthly benefit amount
- Benefit period (2 years, 5 years, lifetime)
- Inflation protection
- Elimination period (typically 30–90 days before benefits begin)
Review your or your loved one’s existing insurance policies — many families discover LTC coverage they didn’t know existed.
Veterans Benefits
Eligible veterans and surviving spouses may qualify for the VA Aid and Attendance benefit, which can provide up to $2,800/month toward nursing home care costs. Eligibility requires:
- At least 90 days of active duty service (with at least 1 day during a wartime period)
- Honorable discharge
- Meeting health and financial eligibility requirements
Contact the Missouri Veterans Commission at (800) 955-2816 for assistance with VA benefit applications.
Life Insurance Conversion (Life Settlements)
A life insurance policy can sometimes be converted or surrendered to help fund long-term care. Options include:
- Life settlement: Sell your policy to a third party for a lump sum (more than cash surrender value, less than death benefit)
- Accelerated death benefit: If the policy has this rider, access a portion of the death benefit while living
- 1035 exchange: Convert a life insurance policy into a long-term care annuity tax-free
Reverse Mortgage
Homeowners 62+ can access home equity through a reverse mortgage (HECM) to fund nursing home care. This is a complex financial product — consult an independent financial advisor before proceeding. Note that a surviving community spouse’s right to remain in the home is protected.
Free Help with Nursing Home Financial Questions
A Place for Mom’s advisors understand Missouri’s payment landscape and can connect you with Medicaid specialists and VA benefit experts — at no cost to families.
Get Free Financial Guidance →Related Resources
