Medicare won’t cover my mom’s special care, and the nursing home is demanding her Social Security. Is this legal, and what are our options?

Unfortunately, paying for this care can be very difficult: SeniorLiving.org says the median price of a semi-private room in a nursing home is $114,665 per year, as of 2025 (2).

Let’s say that your 82-year-old mother spent a month in the hospital and was sent to a skilled nursing facility because she’s unable to manage on her own.

However, her insurance claims she doesn’t need care, and the nursing home wants to take all her Social Security and pension checks to pay the bills.

Can the nursing home take that money, even though your mother has bills to pay, debts she took on before getting sick and a home she wants to maintain after she gets out of the care facility?

If you or anybody else is in a similar position, here’s what you need to know.

Can a nursing home or skilled nursing facility take your money?

The first thing to know is that Medicare is probably your mom’s insurer, as it covers most Americans who are 65 and over.

If your mom has chosen a Medicare Advantage Plan, it will be administered by a private insurer, and it must cover all that Medicare does.

Medicare doesn’t ever cover routine nursing care (called custodial care) for those who can’t do basic life tasks. Medicare does cover skilled nursing care for up to 100 days, but only under limited circumstances, such as when you’ve just left the hospital.

Since your mother just left the hospital, you may want to appeal the denial of the skilled nursing care. If her doctor or care provider believes your mother needs professional care, you should see if they’ll support your efforts to file an appeal with Medicare.

Medicare has information on how you can appeal a denial to try to get covered.

If your appeal isn’t successful, your mother will be considered a private pay patient. While she won’t have her benefits seized, she will be billed for nursing home care and expected to pay the bills. Nursing homes usually bill in advance, so she’ll have to cover her costs to keep her place.

If your mother cannot pay, the nursing home can ask her to leave with “reasonable and appropriate notice” if she’s not in the process of applying for Medicare or Medicaid.

Medicaid does pay for nursing care, but she has to qualify, which means she can’t have countable property or resources above $2,000.

Once she is on Medicaid, she will be required to send her Social Security checks to the nursing home, minus a small personal-needs allowance and minus other insurance premiums she may be paying.

So, unfortunately, based on the current rules, the nursing home can take almost all your mom’s money if she isn’t successful at appealing and getting Medicare to cover her skilled care — but she still needs to be in a home.

Start thinking long-term

If you’re trying to look out for your mother, there’s another thing you have to consider.

Women tend to live longer than men — and that extra time often comes with higher health risks. Older women are more likely than men to face serious health issues later in life — and that increases the chances they’ll eventually need long-term care.

According to the American Association for Long-Term Care Insurance, 51% of women over 65 will require long-term paid care, compared with just 39% of men in the same age group (3).

One big reason for that gap is chronic illness and disability. About 61% of women are expected to develop a chronic disability at some point in their lives, which significantly raises the likelihood of needing ongoing care.

That difference also shows up in the cost of protection. Because women statistically require care more often and for longer periods, insurers typically charge 30% to 40% higher premiums for the same amount of long-term care coverage.

The best thing to do to avoid this happening is to be prepared for the chance of going into a nursing home by thinking long-term — and perhaps buying long-term care insurance.

Long-term care insurance offers coverage for the costs of in-home assistance, nursing homes or assisted living facilities.

Without proper planning, paying for long-term care could deplete your retirement fund. In many cases, the burden of paying for care often falls on family members — potentially straining their finances.

When considering long-term care insurance, GoldenCare offers different options based on your needs, including hybrid life or annuity with long-term care benefits, short-term care, extended care, home health care, assisted living and traditional long-term care insurance.

Consult an expert

Long-term care insurance is one option, but there are others, too.

For example, you can always choose to talk with an elder law attorney to help you appeal the Medicare denial or see what can be done to protect your mom’s assets, but nursing home planning usually needs to begin long before the time care is needed.

If your mother’s benefit checks are big enough to cover the nursing home, and if you can put payments on her other debt and on her mortgage into forbearance, that may be your best bet if the situation is really temporary and she hopes to return home.

If the nursing home costs too much and she can't afford the fees, looking into a home health aide could be an option, too.

If you’re still unsure how your mother’s financial situation stacks up — and feeling overwhelmed by so many options — a financial advisor can help you run the numbers and work those long-term care costs into a secure retirement plan.

That’s where platforms like Advisor.com come in. With their help, you can find a reputed FINRA/SEC-registered advisor near you for free in just minutes.

Here’s how it works: Simply enter some basic information about yourself and your financial goals, and Advisor.com’s AI-powered technology will comb through its network to match you with the best fit.

But hiring an expert can be a lifelong commitment. That’s why Advisor.com lets you set up a free initial consultation with no obligation to hire to see whether your match is the right fit for you.

Start small, even if you’re starting late

With such stringent rules around long-term care, it’s also critical that older Americans have a strong financial cushion for their last years to help them manage the cost of long-term care.

Starting early is key, but you can always start small.