Ways to Receive and Pay for Care


There comes a point when a spouse or other loved one can't provide care any longer, either due to financial, emotional, or health reasons. That may lead to the need to find a long-term care provider. Some people make arrangements ahead of time, especially if there is a family history to consider, but most are in response to an immediate or impending need. The list below will give you a general idea.

Here are some of the many ways people receive and pay for care:

  • Out of their own pocket (or their kids') so they can stay at home in a dignified setting for as long as possible. 1
  • Qualify for Medicaid (MediCal in California). 2
  • Downsize your home to live in a community that has progressive care included in the association costs.
  • Move into an assisted living facility.
  • Receive a reimbursement check from a traditional long-term care insurance policy. 3
  • If someone goes directly into a skilled care facility after a hospital stay of three days or longer, Medicare may pay for the first 20 days and a portion of the costs for the next 40 days or so. That's all Medicare might cover, if it does at all. 4
  • Start saving the amount equal to the premium and build an account earmarked exclusively for potential care costs. 5
  • Set aside enough assets to have the interest pay insurance premiums. 5
  • Receive assistance in your community or from a religious organization. 6


  1. Very few people have acquired insurance to cover these costs. Most are paying from their own personal savings, or that of their children. Some people purchased hybrid annuities that are a combination of a deferred annuity with a long-term care or chronic illness component. If you or a spouse needs care, you can access the funds in the annuity without having to pay federal taxes on the withdrawals. It’s important to understand the surrender charges as they may be high and the surrender periods may be long. However, you can always access up to 10% of your original premium payment, as with any annuity.
  2. More common for a single person or surviving spouse. Be sure to consult an elder law attorney before considering or applying for Medicaid. Keep in mind that it only covers costs in skilled care facilities and there may not be space available close to where your surviving loved ones live.
  3. Many older policies with annual premium payments have seen significant premium increases in the last several years. Realize that policies that are not paid up or have contractual payment arrangements may continue to increase over time. California has passed a law limiting premium increases in the future, which may lead more companies to eliminate some forms of coverage.
  4. That is all Medicare will cover. Medicare may not pay anything if someone goes into a facility from anywhere other than a hospital and it will pay nothing for home care either. The facility must be Medicare certified. Most other health insurance does not provide any coverage for a long-term care need.
  5. People need to start this early enough in life so the funds have time to build. It's a very good idea if you plan to self-insure
  6. Some valuable resources can be found on our Long-Term Care Resources page.