New Jersey Elder Law Attorney

Medicare provides limited coverage for long-term care. The program pays for skilled nursing facility care only when specific conditions are met. First, the patient must be hospitalized for at least three consecutive days. Second, they must enter the skilled nursing facility within 30 days of hospital discharge. Third, they must require skilled nursing or therapy services.

When these conditions are met, Medicare covers the first 20 days in full. For days 21 through 100, Medicare requires a daily copayment that exceeds $209.50 in 2025. After 100 days, Medicare coverage ends entirely, regardless of the patient’s continued need for care.

Medicare does not cover custodial care, which is the type of assistance most long-term care recipients need. Custodial care includes help with activities of daily living such as bathing, dressing, eating, toileting, transferring, and continence management. Because most long-term care is custodial rather than skilled, Medicare provides minimal help with long-term care costs.

Many families initially pay for care using retirement savings, investment accounts, Social Security income, and pensions. While this approach provides maximum choice in care settings and services, it quickly depletes resources that families spent decades accumulating.

At $14,000 per month for nursing home care, a family with $200,000 in savings will exhaust those funds in less than 15 months. For couples, this is particularly problematic because the healthy spouse still has living expenses and may face their own care needs in the future.

Long-term care insurance policies pay for nursing home care, assisted living, and home care. However, relatively few New Jersey families purchased these policies before they became prohibitively expensive. Additionally, many older policies have significant limitations, require waiting periods before benefits begin, and may not cover the full cost of care.

For those who have long-term care insurance, understanding the policy’s terms is essential. Families should know what triggers coverage, which services are covered, how much the daily benefit is, whether benefits increase with inflation, and how long benefits last.

The Department of Veterans Affairs provides Aid and Attendance benefits to wartime veterans with limited income and assets who need help with activities of daily living. These benefits can provide up to $2,358 per month in 2025 for a single veteran, $2,795 for a married veteran, or $1,515 for a surviving spouse.

Aid and Attendance benefits can pay for in-home care, assisted living, or nursing home care. However, veterans must meet strict eligibility requirements regarding military service, income, assets, and medical need. The application process takes several months, and incomplete applications often result in denials.

Medicaid covers long-term care in nursing homes, assisted living facilities (through the assisted living waiver), and at home (through various home and community-based services waivers). However, Medicaid is a needs-based program with strict asset and income limits. Single individuals must have no more than $2,000 in countable assets to qualify. When a married couple applies for Medicaid, the spouse remaining at home can keep approximately $162,660 in assets as of 2026.

Families can use various planning strategies to meet these limits while protecting resources. These include transferring assets to exempt individuals, converting countable assets into exempt assets, purchasing immediate annuities, establishing irrevocable trusts, and restructuring property ownership. The five-year lookback period means that transfers made within five years before applying for Medicaid can result in penalty periods of ineligibility.