Paying for care

Part A is hospital insurance and also covers short skilled nursing facility stays, hospice and some home health care. Part B is medical insurance for doctor visits, outpatient care, medical equipment and preventive services. Part C, called Medicare Advantage, is a private plan approved by Medicare that bundles A and B, and usually D, in place of Original Medicare. Part D covers prescription drugs, either as a stand-alone plan or inside a Medicare Advantage plan.

No. Medicare does not pay for long-term custodial care, which means everyday help with things like bathing, dressing, eating and supervision, whether that help is given at home, in assisted living or in a nursing home. Medicare pays for short-term skilled care when strict conditions are met. Families usually pay for long-term care with their own money, Medicaid, VA benefits or long-term care insurance.

Original Medicare covers a short-term stay when the person had a medically necessary inpatient hospital stay of at least three days in a row (not counting the day of discharge), needs daily skilled nursing or therapy, and goes to a Medicare-certified facility, usually within 30 days of leaving the hospital. Time spent in the emergency room or under “observation” does not count toward the three days. Coverage is limited to up to 100 days per benefit period. For 2026, Medicare.gov lists $0 per day for days 1 to 20 after the Part A deductible of $1,736, $217 per day for days 21 to 100, and all costs after day 100.

Medicare covers part-time or occasional skilled care at home, such as nursing or therapy, when a doctor or other qualified provider orders it and the person is considered “homebound,” meaning leaving home takes considerable effort. It does not cover round-the-clock care, home-delivered meals, housekeeping that isn’t part of the care plan, or personal care like bathing and dressing when that is the only help needed. A Medicare-certified home health agency must provide the care.

When a hospice doctor and the person’s regular doctor certify a life expectancy of six months or less, and the person chooses comfort care instead of treatment meant to cure the illness, Medicare covers hospice from a Medicare-approved provider. There is usually no charge for the hospice care itself, though there can be small copays for some drugs and for inpatient respite. Medicare does not pay room and board, so if hospice is provided in a nursing home or assisted living, the family may still owe that monthly cost.

No. Medigap policies help pay the deductibles, coinsurance and copays left over from Original Medicare, but they do not pay for long-term custodial care. They are a good way to make Medicare-covered costs more predictable, not a way to pay for a nursing home or assisted living stay over time.

The best time is the six-month Medigap Open Enrollment Period, which starts the first month a person is 65 or older and enrolled in Part B. Outside that window, there is generally no federal guarantee an insurer will sell a policy, and health problems can raise the price or lead to a denial, although some situations give special “guaranteed issue” rights. Medigap only works with Original Medicare; it is illegal for anyone to sell a Medigap policy to someone who has a Medicare Advantage plan.

Medicare Advantage plans often use a network of providers, may require a referral to see a specialist, and may require approval from the plan before certain services, which is called prior authorization. They do have a yearly limit on out-of-pocket costs for covered services and may add extras like dental, vision or hearing. Some plans waive the three-day hospital rule for skilled nursing care but may charge copays from the first day. Before a planned move to rehab, home health or a facility, call the plan to confirm the provider is in network and whether approval is needed.

Yes, for people who qualify both medically and financially. Medically, the person must need the level of care a nursing home provides. Financially, Utah Medicaid looks at income and countable assets, and the rules for married couples are different from the rules for single people. Eligibility is decided month by month, so it can change.

Utah’s 2026 Medicaid program summary lists an asset limit of $2,000 for a nursing home resident. Some things are not counted or are only partly counted, such as one vehicle, ordinary household goods, prepaid burial items, and in some cases the home. What counts and what doesn’t can be complicated, so ask a Department of Workforce Services eligibility worker or an elder law attorney about your specific situation before moving or spending any money.

Most residents keep a small personal needs allowance, which Utah lists as $45 a month, and the rest of their income goes toward the cost of their care. Certain amounts can be deducted first, such as health insurance premiums, and part of the income may go to a spouse who still lives at home. Medicaid then pays the remaining approved cost.

Utah follows spousal impoverishment rules so the spouse at home is not left without money. In general terms, the at-home spouse may keep about half of the couple’s countable assets, within a minimum and maximum that change each January; Utah Medicaid’s table lists $32,532 and $162,660 for 2026. The at-home spouse may also be able to keep part of the nursing home spouse’s income for living expenses. These calculations are detailed, and an elder law attorney or DWS worker can explain how they apply to you.

When someone applies for long-term care Medicaid, Utah looks back 60 months (five years) at gifts and other transfers. Giving away money or property for less than its fair value during that time can lead to a penalty period when Medicaid will not pay for long-term care. Some transfers are exempt, such as transfers to a spouse or to a blind or disabled child. Talk with an elder law attorney before giving away assets or adding a child to a deed or account.

Spend-down is the common term for reducing countable assets or income to the level Medicaid allows, usually by paying for care and other permitted expenses. Spending must be for fair value; giving money away is treated as a transfer and can cause a penalty. Because a mistake can delay coverage, it’s wise to get advice from an elder law attorney or a DWS eligibility worker before making large purchases or payments.

Medicaid does not take a home outright, and a home can sometimes be exempt while the person or their spouse or certain relatives live there, up to a home equity limit that Utah Medicaid lists as $752,000 for 2026. After death, Utah’s estate recovery program must seek repayment of Medicaid costs for people who were 55 or older, but it does not recover while a spouse is living or when a minor, blind or disabled child is involved. An elder law attorney can explain how this may affect your family’s home.

The Utah Department of Workforce Services (DWS) decides Medicaid eligibility. You can apply online through jobs.utah.gov, by mail or fax, or at a DWS office. For case questions, DWS lists 801-526-0950 in the Salt Lake area and 1-866-435-7414 toll-free, Monday through Friday, 8 a.m. to 5 p.m. Have proof of identity, income, assets and recent medical bills ready, and apply as close as possible to the date care begins.

A waiver lets Medicaid pay for services at home or in the community for people who would otherwise need nursing home care. In Utah, these include the Aging Waiver, the New Choices Waiver, and several waivers for people with disabilities or brain injuries. Each waiver has its own rules, services and contact point.

The Aging Waiver is for people 65 or older who need nursing facility level of care and meet Medicaid financial rules, and it helps them stay at home with services like help with household tasks. Referrals start with your local Area Agency on Aging, whose case manager evaluates eligibility. The Division of Aging and Adult Services at 801-538-3910 can connect you with your local agency.

New Choices helps people who already live in a nursing facility, assisted living or similar licensed setting move to a community setting, such as their own home, a family member’s home or certain assisted living and residential settings, when their needs can be met safely there. Applicants must need nursing facility level of care and meet minimum length-of-stay rules, such as 90 days of Medicaid-paid nursing facility care or 365 days in a licensed assisted living facility. The program serves a limited number of people. Call 801-538-6155 (option 6) or 1-800-662-9651 (option 6).

PACE (Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program for people 55 and older who need nursing home level care but can live safely in the community. It is only offered in states that provide it through Medicaid and only in a PACE organization’s service area. Utah Medicaid’s list of long-term care and waiver programs did not include PACE when we checked. To see if anything has changed, use the PACE search on Medicare.gov or call 1-800-MEDICARE.

Possibly. Utah’s Division of Aging and Adult Services funds an Alternatives Program for lower-income older adults who want to stay at home, and a Caregiver Support Program for unpaid family caregivers that has no low-income requirement. Services can include respite, counseling, support groups and supplies. Your local Area Agency on Aging handles both.

Extra Help is a federal program that lowers Part D drug costs, including premiums, deductibles and copays, for people with limited income and resources. People with full Medicaid, SSI, or a Medicare Savings Program qualify automatically. For 2026, Medicare.gov lists limits of $23,940 in income and $18,090 in resources for an individual, and $32,460 and $36,100 for a married couple. You can apply through Social Security, and a SHIP counselor can help for free.

These state-run programs help pay Medicare premiums and, for some people, deductibles and coinsurance. Utah calls them Medicare Cost-Sharing Programs and offers QMB, SLMB and QI, each with its own income limit. Medicare encourages people to apply even if they’re not sure they qualify. Apply through the Utah Department of Workforce Services.

Utah’s Senior Health Insurance Information Program (SHIP), run through the Division of Aging and Adult Services, offers free Medicare counseling to people with Medicare, their families and caregivers at 1-800-541-7735. Counselors can compare Medigap and Medicare Advantage options, check drug plans, and help with Extra Help and Medicare Savings Program applications. They do not sell insurance.

Aid and Attendance is an extra monthly amount added to a VA pension for a veteran or surviving spouse who needs help with daily activities like bathing, eating or dressing, is mostly bedbound, lives in a nursing home because of a disability, or has very limited eyesight. The person must qualify for the VA pension first, which has its own service, income and asset rules. Applications use VA Form 21-2680, completed in part by a medical examiner, and nursing home residents also send VA Form 21-0779.

It can. Veterans enrolled in VA health care may get home and community services such as adult day health care, home health aides and respite when there is a clinical need and the service is available locally. Nursing home care through VA depends on service-connected status, disability rating and income, and copays can apply starting on the 22nd day. VA does not pay room and board in assisted living. Being paid VA disability compensation does not automatically enroll someone in VA health care, so enroll first.

Community care lets an enrolled veteran see a non-VA provider, paid by VA, in certain situations, such as when VA doesn’t offer the service, can’t meet its drive-time or wait-time standards, or when the veteran and VA provider agree it is in the veteran’s best medical interest. In general, the VA care team must approve community care before the visit, except for urgent or emergency care. If a request is denied, there is a clinical appeal process.

Utah has four: the William E. Christoffersen Salt Lake Veterans Home (801-584-1900), the George E. Wahlen Ogden Veterans Home (801-334-4300), the Mervyn Sharp Bennion Veterans Home in Payson (801-465-5400), and the Southern Utah Veterans Home in Ivins (435-634-5220). According to the Utah Department of Veterans and Military Affairs, veterans with a service-connected disability rating of 70% or higher pay no cost for care, and care for other eligible veterans is partly paid by VA. Spouses and Gold Star parents may be admitted, but VA does not subsidize their cost. Call the home directly to ask about openings and how to apply.

The Utah Department of Veterans and Military Affairs has Veteran Service Officers who help with VA claims; call 801-326-2372 or 800-894-9497 to find one near you. VA-accredited organizations such as the American Legion, DAV and VFW also help with claims. Before paying anyone for help with a VA application, or moving assets to qualify for a pension, talk with a Veteran Service Officer, a VA-accredited representative or an elder law attorney.

Long-term care insurance pays a set daily or monthly amount, up to the limits in the policy, for help with daily activities at home, in a community program or in a facility. Many policies cover a set number of years; a few pay for life. Premiums depend on age at purchase, the benefit amount and options like inflation protection, and they can go up later. People in poor health or already receiving care often can’t qualify for an individual policy.

Call the insurer early and ask for a claim packet. Ask what the policy requires before benefits start, such as a waiting period or proof that the person needs help with a certain number of daily activities, and which providers or settings are covered. Keep copies of everything you send and write down who you talk to.

Sometimes. Some policies allow an accelerated death benefit, which pays part of the death benefit early when someone is terminally ill or needs long-term care. Policies can also sometimes be sold for cash through a life settlement, or, for a person who is terminally ill, a viatical settlement. These choices usually reduce or end what heirs receive, can affect Medicaid eligibility, and may have tax effects, so talk with the insurer and a financial or legal advisor first.

Be careful. A federally insured reverse mortgage (HECM) is a loan for homeowners 62 and older, not free money, and the borrower must keep paying property taxes, insurance and upkeep. The loan can come due if the last borrower lives in a care facility for 12 months or more in a row, and a spouse who isn’t on the loan may not be able to keep receiving money. Federal rules require counseling with a HUD-approved counselor before getting one; the Consumer Financial Protection Bureau lists (800) 569-4287 to find a counselor.

They can be. If you itemize, medical expenses for yourself, your spouse or a dependent, including a parent you support, may be deductible to the extent they exceed 7.5% of adjusted gross income. The IRS allows the full cost of a nursing home, including meals and lodging, when medical care is the main reason for being there; otherwise only the medical portion counts. Qualified long-term care services and part of long-term care insurance premiums may also count. Ask a tax professional how the rules apply to your family.

Many families start by paying with savings, pensions or the sale of a home. Ask each provider for a written list of what the monthly rate includes and what costs extra, how and when rates go up, and what happens if money runs out. If Medicaid may be needed later, ask before moving in whether the facility accepts Medicaid and whether a resident can stay after switching.

For Medicare questions, call Utah SHIP at 1-800-541-7735. For local programs, caregiver support and the Aging Waiver, contact your Area Agency on Aging. For Medicaid eligibility, call the Department of Workforce Services. For VA benefits, contact a Veteran Service Officer through the Utah Department of Veterans and Military Affairs. For legal questions about assets, Medicaid planning or estate recovery, an elder law attorney is the right person, and Utah Legal Services may help people with low incomes at no cost. Utah Care Network is also free for families.