Worked example · updated 2026-08-03

What a Year of Care Costs, and What Medicare Pays Toward It

A hypothetical household in Ohio compares a nursing home, assisted living, and thirty hours a week of help at home. The figures come from a cost-of-care survey. The share of them Medicare pays, once the care is long-term rather than skilled, is nothing at all.

Illustrative worked example. The household is hypothetical; every figure is computed by the same verified engines and rule packs the calculators use.

The situation

A hypothetical Ohio household is working out what care would cost for a parent who can no longer manage alone but is not ill in any way a hospital would treat. They look at three options: a nursing home, an assisted-living residence, and thirty hours a week of paid help at home. They assume, as most people do, that Medicare will carry a meaningful share of whichever they choose. The figures below are state medians from the cost-of-care survey, converted to monthly and yearly amounts using that thirty-hour schedule.

What goes in

State: OH
Hours of home care a week: 30
Survey year: 2025

What comes out

A year of nursing-home care at the median for this state

$124,668

none of which Medicare pays, once the care is long-term rather than skilled

Nursing home, a month: $10,389
Assisted living, a month: $6,103
Home aide at 30 hours a week, a monthhours a week is the single biggest lever on this figure: $4,420
Difference between a year at home and a year in a nursing home: $71,628

Verified 2026-08-02 against CareScout (formerly Genworth) Cost of Care Survey 2025, fielded July-November 2025 (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.

Medicare does not pay for long-term custodial care

This is the sentence that reorganises the whole conversation, and it surprises almost everyone. Medicare pays for skilled care: a hospital stay, a limited period in a skilled nursing facility after one, home health where a clinician is treating something. It does not pay for custodial care, which means help with bathing, dressing, eating, moving and remembering — the help nearly every figure on this page actually buys. The distinction is not about where the care happens or how badly it is needed. It is about whether it is medical treatment.

The hours are the lever, not the hourly rate

Care at home is priced by the hour, so the monthly figure is a product of two numbers, and the schedule moves it far more than the rate does. Thirty hours a week is roughly four hours a day with a day off, which is a realistic amount of help for someone still managing most of their own day. Double it and the arithmetic changes the ranking of the options entirely. That is why hours are shown as an input here rather than buried as an assumption: any comparison that hides the schedule is comparing something the reader did not choose.

Medians describe the middle, not the price anyone is offered

Every figure here is a survey median, which means half the providers surveyed charged more and half charged less. No provider is bound by a median, prices differ sharply between neighboring towns, and the survey is a year or more old by the time anyone reads it. The figures are the right size for planning and the wrong size for budgeting a specific placement. The only number that governs a real decision is the one in writing from the provider being considered, and it is worth collecting three of those.

Where the money actually comes from

For most households the answer is a sequence rather than a single source: savings and income first, then long-term-care insurance if there is a policy, then Medicaid once assets have been spent down to a state's limit. Veterans and surviving spouses may reach an Aid and Attendance payment that is not means-tested in the way Medicaid is. Each of those has its own rules, its own paperwork, and its own timing traps — and the one that catches people is Medicaid's look-back at transfers made before applying.

What this example is good for

The gap that ruins plans is not the price of care; it is the assumption that Medicare shares it. Establishing that it does not, before a placement is urgent, is what turns this from a crisis decision into a planning one — and the look-back rules mean the planning has to happen early to be worth anything.

Run this with your own numbers — Care Costs

What in-home care, adult day programs, assisted living and nursing homes cost in your state, converted to monthly and yearly figures from the hours you actually expect to use. The survey publishes each kind of care in a different unit, so the arithmetic that makes them comparable is ours, and it is printed beside every number. Estimate only.

Calculators behind this example

Care Costs

Look-Back

Medicaid examines a five-year window before an application, looking for gifts and property transfers, and one found there creates a penalty period that starts only once the money has already run out. Here is how that works, how fast a spend-down happens, and a printable worksheet. Not legal advice — your state agency decides.

Funding Screener

Seven questions, none of them about who you are, and the answer is a list of offices rather than a verdict: Medicare Savings Programs, Medicaid long-term care, VA pension, your free state counselors, the area agency on aging, and an elder-law attorney if property is involved. Each one names who decides and what to bring. Estimate only, never a determination.

Estimate only — not financial, tax, legal, or insurance advice. Only the provider quoting you can determine your actual amounts.

Official source: CareScout (Genworth) Cost of Care Survey ↗

Works offline — your inputs never leave this device. How that works

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