Marriage is all about communication and compromise, and when one spouse needs a nursing home, that relationship of mutual decision-making is essential. It is no easy choice to make to split up the living situation of a married couple, though it may be in both parties’ best interest. There are many potential reasons why one member of a marriage may need nursing home care, but the choice ultimately comes down to the physical, emotional, and financial wellness of both spouses.  

Methods of Paying for a Nursing Home

Nursing home care is not inexpensive. The national average cost is almost $300 a day for a private room, and a shared room is not much cheaper. While this makes the national average around $95K–110K, some states, like Massachusetts or Alaska, may be closer to two or even three times that amount. With such rates, a financial plan needs to be established when one spouse needs a nursing home. This plan needs to take into account which spouse is the primary earner for the family, which assets are in reserve, and which other resources are available.

Determining how to pay for nursing home care can be overwhelming. Those considering it should know that there are four primary ways people pay for nursing home care. Each has its pros and cons:

Self-Pay

Self-Pay is often the first line of financial defense when one spouse needs a nursing home. Funds for nursing home care come out of pocket until they are dramatically depleted and the couple qualifies for government assistance.

Medicare

Medicare is a federal financial program that is available for a finite time. The program is geared toward patients only entering a nursing home temporarily as part of a recovery regime after surgery or accident. The requirements for receiving Medicare funds are strict, and the coverage is limited. 

Only those 65 years and older and some younger applicants with specific disabilities are eligible to receive financial aid. A common cap for funding is 100 days of care in a skilled nursing facility after distinct spells of illness. More specific requirements and the benefits provided are dependent on the state in which patients reside and the plan in which they enroll.

Medicaid

Medicaid is the most common recourse when both or one spouse needs a nursing home. Another federal funding program, Medicaid is in place to assist patients over 65 years old receive the care they need despite restricted incomes. As with Medicare, Medicaid enrollment requirements and funding allotments vary by state; the federal government provides partial funding in the form of grants and funds and each state interprets and enforces eligibility guidelines as it deems appropriate.

Long-Term Care Insurance

Long-Term Care Insurance hasn’t been a contender for providing supplemental nursing home funding for long, so while it is gaining popularity, it is a relatively uncommon method. As the name implies, it is geared toward those planning their nursing home funding well in advance. Applicants must apply while healthy, and such a long-term policy at high premiums can be expensive, though the insurance can secure payment for many facets of nursing home care without the same restrictions as federal aid. 

How Is Funding Divided When One Spouse Needs a Nursing Home

When only one spouse needs a nursing home, Medicaid law has special provisions in its delegation of funds. This is known as Division of Assets, and it is in place so no one spouse has to live in poverty when nursing home care is introduced. 

The first element of division of assets is the gathering and accounting of assets. The assets available to the couple are pooled, valued, and distributed between the two spouses. Most of the funds go to the spouse remaining at home—referred to legally as the community spouse or non-applicant spouse—capping at the Medicaid-determined Community Spouse Resource Allowance (CSRA).

Division of continuous income is based on which spouse is the breadwinner. A part of the  income earned by the applicant spouse goes to the nursing home, but a portion known as the Minimum Monthly Maintenance Needs Allowance (MMMNA) is sent to the non-applicant spouse to ensure that person does not live in poverty. Income generated by the non-applicant spouse does not go to the nursing home except to pay the applicant spouse’s dues. 

The best path forward when one spouse needs a nursing home is not always clear. The decision is fraught with change and often stress, and the finances involved in the process are only a piece of the choice. Every couple’s experience will be unique, and they must find the right care for them.