Families usually pay for assisted living from a mix of sources: the parent's income (Social Security, pensions), savings, and often the sale of a home, sometimes with long-term care insurance, VA pension with Aid and Attendance, or family contributions. Medicaid can pay for care services in 44 states but not room and board. Medicare generally pays for neither.
Key facts
- As of March 2025, 44 state Medicaid programs covered assisted living services, but federal rules don't allow Medicaid to pay for room and board. (U.S. GAO, 2026)
- Medicare generally does not cover assisted living services or room and board. (U.S. GAO, 2026)
- The 2025 national median cost of assisted living was $6,200 a month. (CareScout, 2026)
- A reverse mortgage generally becomes due if the borrower lives in a health care facility such as assisted living for more than 12 consecutive months, unless an eligible non-borrowing spouse or co-borrower remains in the home. (CFPB, 2024)
- Most long-term care insurance policies sold today reimburse actual expenses up to a limit. (NAIC, 2019)
The monthly bill for assisted living is often larger than your parent's monthly income, so the real question is how to cover the gap, and for how long. There isn't one right mix. It depends on what your parent owns, what they qualify for, and what they want. This post lays out the common sources side by side, shows how to calculate the gap, and tells you which professional answers which question. The linked posts go deeper on each source.
The common ways to pay, side by side
The table lists the usual sources, what each can cover, and the main catch. Expect to combine more than one.
| Source | What it can pay | Main catch | Who to ask |
|---|---|---|---|
| Parent's income (Social Security, pensions, annuities) | Anything | Usually less than the monthly bill | Your parent, their statements |
| Savings and investments | Anything | Taxes and penalties may apply on some withdrawals | Tax professional, financial planner |
| Sale of the home | Anything, once sold | Takes months; can affect benefits | Real estate agent, elder law attorney, tax professional |
| Long-term care insurance | Care costs up to the policy limit, if the community qualifies | Benefit triggers and an elimination period first | The insurer; state insurance department |
| Life insurance with a long-term care rider | Part of the death benefit, paid early | Reduces what beneficiaries receive | The insurer |
| VA pension with Aid and Attendance | A monthly amount your parent can use toward anything | Wartime service, need, income and net worth limits | VA-accredited representative |
| Medicaid | Care services, in 44 states | Not room and board; strict limits; possible waitlists | State Medicaid agency, elder law attorney |
| Family contributions | Anything | Strain between siblings if unclear | A family meeting, written down |
| Short-term loans (bridge loan) | Costs while waiting for a sale or benefits | Interest and fees; must be repaid | The lender; financial planner |
Medicare is missing on purpose. The GAO's 2026 report on assisted living says Medicare generally does not cover assisted living services or room and board.
Start by working out the monthly gap
Before you look at any program, work out three numbers. You'll need them for every conversation with a community, a sibling or a professional.
- Monthly cost. The community's full monthly bill at your parent's care level, plus outside costs like pharmacy and insurance premiums. For reference, the 2025 national median for assisted living alone was $6,200 a month (CareScout Cost of Care Survey).
- Monthly income. What reliably arrives each month after deductions: Social Security, pensions, annuity payments.
- Available savings. What can be used without selling the house.
The monthly gap is cost minus income. Savings divided by the gap gives a rough number of months before savings run out.
A hypothetical example: say the full monthly cost is $7,000, your mom's income is $2,800, and she has $150,000 in savings. The gap is $4,200 a month. $150,000 divided by $4,200 is about 35 months, not counting rate increases, which shorten it. That number tells you how much time you have to plan for the next source, whether it's a house sale, a VA claim or a Medicaid application.
The assisted living budget post has a line-by-line worksheet for the cost and income sides.
Who pays for room and board, and who pays for care
Assisted living bills have two parts: room and board (housing, utilities, meals) and care services (help with bathing, dressing, medications). Payment sources treat them differently.
- Medicaid can pay for care services in the 44 states that cover them, but federal rules don't allow it to pay room and board. Your parent usually pays room and board from income. See does Medicaid pay for assisted living.
- VA pension with Aid and Attendance is paid to your parent as monthly income, so it can go toward either. VA describes it as an amount added to a monthly VA pension. See VA Aid and Attendance and assisted living.
- Long-term care insurance pays according to the policy. Most policies sold today reimburse actual expenses up to a limit, per the NAIC, and whether room and board counts depends on the policy. See using long-term care insurance for assisted living.
Should the house be sold, rented or borrowed against?
For many parents, the house is the largest asset, and the choice of what to do with it shapes everything else. Three common paths:
- Sell it. Turns equity into cash but takes months, and the proceeds can change eligibility for Medicaid and VA pension. The order of steps is covered in selling the house to pay for assisted living.
- Rent it out. Keeps the house and adds income, but brings landlord work, repairs and vacancies.
- Borrow against it. A reverse mortgage depends on the home staying the borrower's principal residence. The CFPB explains that if the borrower lives in a health care facility such as assisted living for more than 12 consecutive months, the loan becomes due unless an eligible non-borrowing spouse or co-borrower remains in the home. A short-term bridge loan is a different product, used while a sale is pending.
Whatever you choose, ask an elder law attorney and a tax professional before listing the house or signing loan papers. The order in which things happen can matter as much as the choice itself.
Can some of the cost count as a medical expense on taxes?
Sometimes. IRS Publication 502 sets the rules for which costs count as medical expenses. It doesn't name assisted living, so bring these rules to a tax professional and ask how they apply to your parent's bills.
- Only the amount above 7.5% of income counts. Medical expenses can be deducted on Schedule A only for the part above 7.5% of adjusted gross income (AGI).
- Care for a chronically ill person can count. Qualified long-term care services count when a licensed health care practitioner prescribed a plan of care for someone who is chronically ill. That means certified within the previous 12 months as unable to do at least two activities of daily living without substantial help for at least 90 days, or as needing substantial supervision because of severe cognitive impairment.
- Meals and lodging depend on the reason for being there. In a nursing home, home for the aged or similar institution, they count if a principal reason for being there is medical care. If the reason is personal, only the part of the cost for medical or nursing care counts.
- A child who pays may be able to include the costs. You can include medical expenses you pay for a dependent. That also covers a parent who would have been your dependent except that their gross income was $5,200 or more in 2025. When siblings share a parent's support, Publication 502 explains how a multiple support agreement decides who can include what.
- Long-term care insurance premiums count up to a limit. The limit depends on age. For someone 71 or older at the end of 2025, it was $6,020 per person.
Questions for the tax professional: Does my parent meet the chronically ill definition, and who would certify it? Can the community's bills show the cost of care separately? Can I include what I pay, and would a multiple support agreement fit our family?
What if the money starts to run out?
The gap math above gives you a rough date. Plan the next source while there are still months left, because benefits can take time to start.
If Medicaid is the likely next step, two facts from a 2026 GAO report matter. As of March 2025, 44 state Medicaid programs covered assisted living services, and 29 of those did it through home and community-based services waivers. The GAO also notes that these waivers let states limit the number of participants, so a spot may not open right away. Your state Medicaid agency can tell you how its program works and whether there is a wait.
The community's own rules matter as much. Ask these questions before signing, or as soon as the money looks tight:
- Does the community accept Medicaid payment for assisted living services?
- If a resident who paid privately becomes eligible for Medicaid, can they stay in the same apartment?
- How much notice does the community give before a move-out for unpaid bills?
- Who on staff helps families with a Medicaid application?
Write down each answer, who gave it and the date. If an answer matters to your decision, ask where it appears in the residency agreement.
When family chips in
When siblings or grandchildren contribute, the trouble usually comes from assumptions nobody said out loud. Agree on four things in writing: who pays how much, whether it's a gift or a loan to be repaid from the estate, who manages the payments, and how you'll review it if costs rise.
To start that conversation with your siblings: "Mom's income covers about $2,800 of the $7,000 a month. Her savings cover the rest for roughly three years. I'd like us to agree now on what happens after that, before we're in a rush. Can we set up a call this week, with the numbers in front of us?"
Keep the family's numbers in one shared place
Parent Move Plan adds a shared costs log and a Fair Share tab that splits the work in hours and shows who lives nearby, so money talks start from the same facts. Every task sits on a date counted back from move-in.
Get your first 3 days freeWhich professional answers which question
No single person covers all of this. Match the question to the right help:
| Question | Who to ask |
|---|---|
| Will Medicaid cover care later? What about the house, gifts, a spouse at home? | Elder law attorney; state Medicaid agency |
| Can my parent get VA pension with Aid and Attendance? | VA-accredited representative (Veterans Service Organization representatives are free) |
| What does the long-term care policy cover, and how do we claim? | The insurer; your state insurance department if there's a dispute |
| What are the tax effects of selling the house or withdrawing savings? Are any costs deductible? | Tax professional; bring IRS Publication 502 for the medical expense rules |
| How long will the money last, and in what order should accounts be used? | Financial planner (CFP Board lets you verify certification and discipline) |
| Medicare plan questions (drug plans, supplements) after the move | SHIP counselor, free and unbiased |
| Local programs, respite, senior services | Area Agency on Aging |
Bring your three numbers (cost, income, savings) to every one of these conversations, plus a list of what your parent owns and any policies you have found, which can save you a second meeting. Bring your parent's own priorities too, such as staying near friends, keeping the house for now or leaving something to a grandchild, and mention them at the start.
Frequently asked questions
Does Medicare pay for assisted living?
Generally no. Medicare does not cover assisted living services or room and board, according to a 2026 GAO report. It may cover other health care your parent receives there, such as hospice.
Can you use a reverse mortgage to pay for assisted living?
Usually not for long. The CFPB explains that if the borrower lives in a health care facility such as assisted living for more than 12 consecutive months, the loan generally becomes due unless an eligible non-borrowing spouse or co-borrower still lives in the home.
Can life insurance pay for assisted living?
Sometimes. Some life policies have an accelerated death benefit rider for long-term care that pays part of the death benefit early when benefit triggers are met. The death benefit then shrinks by the amount used.
What if my parent has almost no savings?
Check Medicaid early. As of March 2025, 44 state Medicaid programs covered assisted living services, though not room and board, and waivers can have waitlists. Your local Area Agency on Aging and the state Medicaid agency can explain the options where your parent lives.
How do people usually pay for assisted living?
Families usually pay from a mix of sources: the parent's income, such as Social Security and pensions, savings, and often the sale of a home. Some add long-term care insurance, VA pension with Aid and Attendance, or family contributions. Medicaid can pay for care services in 44 states but not room and board, and Medicare generally pays for neither.
How do you pay for assisted living with Medicaid?
Medicaid can pay for care services in the 44 states that cover them, but federal rules don't allow it to pay room and board. Your parent usually pays room and board from income. Medicaid has strict limits and waivers can have waitlists, so ask the state Medicaid agency or an elder law attorney how the program works where your parent lives.
Sources
- CareScout: Cost of Care Survey 2025 (accessed Sept 2026)
- U.S. GAO: Assisted Living Facilities, Information on Federal Spending and Medicaid (GAO-26-107884) (accessed Sept 2026)
- NAIC: A Shopper's Guide to Long-Term Care Insurance (accessed Sept 2026)
- CFPB: Moving into a nursing home or assisted living with a reverse mortgage (accessed Sept 2026)
- VA.gov: VA Aid and Attendance benefits and Housebound allowance (accessed Sept 2026)
- CFP Board: Verify a CFP Professional (accessed Sept 2026)
- SHIP National Technical Assistance Center (accessed Sept 2026)
- IRS: Publication 502 (2025), Medical and Dental Expenses (accessed Oct 2026)