What Social Security Can and Cannot Pay For

Social Security retirement or disability benefits do not directly pay for nursing homes, assisted living, or in-home care. Instead, your monthly Social Security check goes into your bank account, and you decide how to spend it — including on long-term care costs if you choose. Social Security itself has no special "long-term care benefit" or coverage that kicks in when you need help with daily activities.

What this means in practice: if you receive $2,000 per month in Social Security, you can use that $2,000 toward rent at an assisted living facility, a home health aide, or adult day programs. But Social Security does not know or care how you spend the money. It is your income to direct as you see fit.

If you are looking for a program that specifically covers long-term care costs — such as nursing home stays or personal care information — you are looking for Medicaid, not Social Security. Medicaid is a separate program that does pay for these services for people with low income and limited assets. Many people use both: Social Security as their monthly income, and Medicaid to cover the care itself.

Key Takeaways

  • Social Security provides monthly income that you can spend on any expense, including long-term care, but it does not cover care costs the way Medicaid does.
  • Your Social Security amount stays the same whether you need care or not — there is no increase or special payment when you move to assisted living or hire a home aide.
  • If your Social Security income is low and you have few assets, you may be able to use Medicaid to cover nursing home or home care costs while using Social Security for other living expenses.
  • Some people reduce their countable assets to become Medicaid-may be able to access while keeping their Social Security benefits, but this requires planning with an elder law attorney to avoid penalties.
  • If you have higher income or savings, you will pay long-term care costs out of pocket until your resources drop low enough for Medicaid to begin.

Using Your Monthly Social Security Check for Care Costs

If you are already receiving Social Security and need care, your monthly benefit can be used to pay for it. A nursing home, assisted living facility, or home care agency will accept your Social Security income as payment, just as they accept any other income. You can arrange for your Social Security check to be deposited directly to a bank account, and then pay the care provider from that account.

The amount you receive does not change based on your care needs. If you were getting $1,800 per month before you moved to assisted living, you will still get $1,800 per month after. The difference is that more of that money now goes toward the care facility instead of rent, food, or other expenses you had before.

In many cases, your Social Security income alone will not cover the full cost of care. A nursing home in many areas costs $8,000 to $10,000 per month or more, while the average Social Security benefit is around $1,800 per month. This is where other resources come in: savings, pensions, long-term care insurance, or Medicaid.

How Medicaid Fills the Gap When Social Security Is Not Enough

Medicaid is a joint federal and state program that pays for long-term care services — nursing homes, assisted living in some states, and home care — for people with low income and limited assets. Unlike Social Security, Medicaid is specifically designed to cover care costs.

To be Medicaid-may be able to access for long-term care, you must meet income and asset limits that vary by state. In most states, your monthly income must be below $2,000 to $2,500, and your countable assets must be below $2,000. Your home, one car, and some personal items do not count toward the asset limit, but savings accounts, stocks, and other liquid assets do.

Here is how the two programs often work together: you use your Social Security income to pay for part of your care or for expenses Medicaid does not cover (such as personal grooming items or phone service). Medicaid then pays the nursing home or care provider for the remaining cost of your care. You keep receiving your Social Security check each month; Medicaid does not take it away.

Each state runs its own Medicaid program with slightly different rules. You will need to contact your state Medicaid office or a local Area Agency on Aging to learn your state's specific income and asset limits and what types of care Medicaid covers in your area.

Planning Your Assets Before You Need Care

If you have savings or other assets but your income is low, you may face a difficult choice: spend down your savings to pay for care until you are poor enough for Medicaid, or plan ahead to protect some assets while still becoming Medicaid-may be able to access.

Some people work with an elder law attorney to set up a trust or make other legal arrangements that reduce their countable assets without triggering Medicaid penalties. For example, an irrevocable trust can hold assets in a way that does not count toward Medicaid's asset limit, though there are strict rules about timing and what you can do with the money. These strategies are legal but complex, and mistakes can result in a period during which Medicaid will not cover your care.

If you straightforward give away money or assets to family members to lower your countable assets, Medicaid will penalize you by delaying coverage. The penalty period depends on how much you gave away and when. This is why planning with an attorney who knows your state's Medicaid rules is important if you have significant assets and think you may need care in the next few years.

Social Security itself has no rules against spending down assets or giving money away. The restrictions come from Medicaid, which is a separate program with its own rules about how you can arrange your finances.

What Happens to Your Social Security If You Move to a Care Facility

Your Social Security benefits continue unchanged when you move to a nursing home, assisted living facility, or hire in-home care. You do not lose your benefits, and the amount does not decrease. The only change is that you are now using that income to pay for care instead of other living expenses.

If you are married and your spouse is still living at home, your spouse's Social Security benefits also continue unchanged. If your spouse is also in the care facility, both of your benefits continue. Medicaid may count your spouse's income and assets differently depending on whether they are still in the community or also in care, so ask your Medicaid caseworker how your spouse's situation affects your coverage.

If you receive Supplemental Security Income (SSI) in addition to Social Security retirement or disability benefits, the rules are stricter. SSI has lower income and asset limits, and living in a care facility may affect your SSI amount. Ask your local Social Security office how a move to care would affect your SSI before you make the move.

When to Talk to a Lawyer or Financial Planner

If you are thinking about long-term care and you have more than a small amount of savings, it is worth talking to an elder law attorney or a financial planner who specializes in elder care. These professionals can help you understand whether you should plan to spend down assets, set up a trust, or pursue other strategies specific to your state's Medicaid rules.

An elder law attorney can also help you understand what will happen to your assets if you need care, how to protect assets for your spouse if only one of you needs care, and what documents you need in place (such as a power of attorney or healthcare proxy) before a crisis happens.

Many Area Agencies on Aging offer free or low-cost consultations with social workers who can explain your state's Medicaid rules and help you think through your options. You can find your local Area Agency on Aging by calling the Eldercare Locator at 1-800-677-1116 or visiting eldercare.acl.gov.

Questions to Ask Your Doctor or Social Worker

Before you need care, it is helpful to have a conversation with your doctor about what kind of care you might need in the future and when. Ask whether your current health conditions are likely to require help with daily activities, and whether that help might be short-term (after surgery or illness) or long-term (ongoing).

If you are already receiving care or thinking about it, ask your care provider or social worker: What is the monthly cost of care here? What does that cost include, and what do I pay separately? Can I use my Social Security income to pay, or do you require a different payment method? Do you work with Medicaid, and if so, what do I need to do to set that up?

Ask your local Medicaid office or Area Agency on Aging: What are my state's income and asset limits for long-term care Medicaid? If I have savings, what happens to them? Are there legal ways to protect some assets, and should I talk to a lawyer about that?

Frequently Asked Questions

Can I use my spouse's Social Security to pay for my care?

Only if your spouse gives you the money. Social Security benefits are paid to the person who earned them, and your spouse cannot direct their benefit to you. However, if your spouse chooses to give you part of their monthly check, you can use that money for your care costs. If you are married and one of you needs care, a financial planner can help you think through how to use both incomes most effectively.

What if I need care but I am not yet old enough for Social Security retirement benefits?

If you are disabled, you may be receiving Social Security Disability Insurance (SSDI), which works the same way as retirement benefits — you can use the monthly check for any expense, including care. If you are not yet receiving any Social Security, you would need to look to Medicaid, Supplemental Security Income (SSI), or other programs. Contact your local Social Security office or Area Agency on Aging to learn what programs you might be able to use.

Does Medicare pay for nursing home or assisted living care?

Medicare covers a limited stay in a skilled nursing facility after a hospital stay (usually up to 100 days), but it does not cover long-term care in a nursing home or assisted living. For ongoing care, you would use your own income (such as Social Security), savings, long-term care insurance, or Medicaid. This is why many people have both Medicare and Medicaid — Medicare covers medical care, and Medicaid covers long-term care services.

If I move to assisted living, do I have to spend all my Social Security on the facility?

No. You can use your Social Security income however you choose. If assisted living costs $3,000 per month and you receive $2,000 in Social Security, you might use all $2,000 toward the facility and pay the remaining $1,000 from savings, or you might use $1,500 for the facility and $500 for personal items, phone service, or other expenses. The choice is yours.

What if I run out of money and cannot pay for care anymore?

If your savings are gone and you have only Social Security income, you can explore for Medicaid to cover your care costs. Medicaid will look at your current income and assets, not what you spent in the past. If you meet your state's income and asset limits at the time you explore, you can be approved. However, if you gave away money or assets within a certain time period before explore (usually five years), Medicaid may impose a penalty period during which it will not pay for care. This is why planning ahead with an attorney is important if you think this situation might happen to you.