Paying for care

Most long-term help is not paid by Medicare. Build a plan around the type of care, eligibility rules, and how long available funds may last. Do not transfer money or property to qualify for benefits without qualified advice.

Your next 3 actions

1. Make a care-and-money snapshot. List monthly income, accounts, property, debts, insurance, veteran status, current care needs, and who has legal authority.
2. Screen for benefits before paying privately. Contact Community Living Connections and Washington DSHS. Ask insurers and the VA for written benefit rules.
3. Compare a full monthly budget under three scenarios. Include care, housing, supplies, transportation, respite, taxes, and likely increases—not only the advertised base rate.

Main payment paths

• Personal funds: Most flexible, but plan for longevity and price changes. Preserve an emergency reserve.
• Medicare: Covers qualifying medical, rehabilitation, home health, and hospice services. It generally does not pay for ongoing custodial long-term care or facility room and board.
• Washington Apple Health (Medicaid): May cover eligible long-term services at home or in a residential or nursing setting. Financial and functional eligibility, program availability, and provider participation matter.
• Long-term care insurance: Benefits depend on triggers, elimination periods, daily or monthly limits, covered settings, and inflation features. Start the claim early and ask for decisions in writing.
• Veterans benefits: VA health care or pension-related benefits may help some veterans and survivors. Eligibility is individual; avoid firms that charge to file a basic claim or pressure asset transfers.
• Family contribution or home equity: Can bridge gaps but may shift risk to relatives or the home. Use independent legal and financial advice before loans, reverse mortgages, deeds, or co-signing.

Questions to ask

• What care is covered, in which setting, and by which approved provider?
• What functional and financial tests apply? Is there a wait or assessment?
• What must be paid first? Are there deductibles, copays, elimination periods, or caps?
• Can the rate rise when care needs change? How much notice is required?
• What happens if private funds run low? Does the provider accept Medicaid, and under what conditions?
• Could benefits paid create estate-recovery exposure later?
• Who may sign, receive notices, appeal, or manage the claim?
• Is the advice coming from someone paid by the product or facility being recommended?

Warning signs

Do not sign a personal guarantee, co-sign debt, add someone to an account or deed, or transfer assets under pressure. Beware promises to “hide” assets, guaranteed Medicaid eligibility, paid access to free VA claim filing, or requests for gift cards, cryptocurrency, passwords, or remote computer access. Report suspected financial exploitation to APS and urgent theft to law enforcement.

Common failures

• Using the sticker price. Request a written, itemized estimate at current and higher care levels.
• Assuming Medicare covers long-term care. Confirm the exact benefit and duration.
• Applying only after savings are nearly gone. Assessments and documents take time.
• Making gifts to qualify for Medicaid. Transfers can affect eligibility and create tax or family conflict.
• Ignoring the well spouse or dependent. Ask DSHS or an elder-law attorney about protections before spending or transferring assets.
• Letting legal authority lapse. Review powers of attorney while the person can still choose.

Costs and payment basics

Ask every provider for base charges, care-level fees, deposits, supplies, transportation, minimum hours, cancellation rules, annual increases, refund terms, and discharge terms. Keep invoices and benefit notices. Medicaid is jointly funded and rules differ by state; Washington DSHS makes eligibility decisions. Estate recovery may apply in defined circumstances, with exemptions and hardship processes. Get case-specific advice from DSHS or a qualified Washington elder-law attorney.

King County help

• Community Living Connections: Ask for options counseling, caregiver support, benefits screening, and local referrals. Call 844-348-5464 or visit https://www.agingkingcounty.org/help/.

• Washington 2-1-1: Dial 211 or use https://wa211.org/ for food, housing, transportation, and other practical needs.

• If there is immediate danger, call 911. If you suspect abuse, neglect, exploitation, or abandonment of a vulnerable adult, contact Washington Adult Protective Services: https://www.dshs.wa.gov/altsa/home-and-community-services/report-concerns-involving-vulnerable-adults.

• Washington DSHS Home and Community Services: Apply for or ask about long-term services: https://www.dshs.wa.gov/altsa/long-term-care-services-information.

• Statewide Health Insurance Benefits Advisors (SHIBA): Free, unbiased Medicare counseling: https://www.insurance.wa.gov/find-local-shiba-office.

Sources

• Medicare, Long-term care: https://www.medicare.gov/coverage/long-term-care
• Medicare, Medicaid: https://www.medicare.gov/basics/costs/help/medicaid
• Washington DSHS, Long-term care services information: https://www.dshs.wa.gov/altsa/long-term-care-services-information
• Washington HCA, Estate recovery: https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/estate-recovery
• U.S. Department of Veterans Affairs, Pension benefits: https://www.va.gov/pension/
• Consumer Financial Protection Bureau, Resources for older adults: https://www.consumerfinance.gov/consumer-tools/educator-tools/resources-for-older-adults/

Reviewed 2026-08-23.