By Michael Cherewka, Esq.
If you’re married, here’s the uncomfortable truth. There’s a very real chance one of you will need long-term care while the other is still living independently. And when that happens, this isn’t just a healthcare issue, it’s a financial one as well. Most families assume that: “We’ll just use savings;” “Insurance or Medicare will cover it;” “We’ll figure it out when the time comes.” Unfortunately, that’s not how it works.
In Pennsylvania, nursing home care can easily run around $10,000 – $14,000 per month. Assisted living and in-home care aren’t much less expensive. And here’s the unfortunate truth: Medicare does not cover long-term care. So many couples start paying out of pocket.
When one spouse needs care, families often hear about Medicaid. But qualifying isn’t automatic. You don’t just apply; you need to financially qualify in order to receive the benefits. This usually means spending down countable assets, repositioning resources, or navigating a strict 5-year lookback period. Without planning, this can feel like watching everything you’ve built slowly disappear.
One concern that often comes up during these conversations is what happens to the healthy spouse, and this is where planning matters the most. Medicaid has protections for the “community spouse” (the one still living at home), including: the ability to keep the home (in most cases), a portion of the couple’s assets, and a monthly income allowance. But, those protections are limited and technical. Done wrong, the healthy spouse can still end up financially strained. I’ve seen situations where the at-home spouse doesn’t have enough income to live comfortably, their savings are unnecessarily depleted, or families make “quick fixes” that create bigger problems later.
The biggest mistake couples make is that they wait too long to plan. By the time care is needed, options are narrower, stress is higher, and decisions are rushed. That’s when costly mistakes happen, like gifting assets incorrectly or assuming the house is automatically protected.
The goal isn’t to “hide money.” It’s to legally protect the healthy spouse while securing care for the one that needs it. This can include strategic asset protection planning, proper titling of assets, trust-based planning, and income planning for the community spouse. Done early enough, this can mean the difference between preserving stability for the healthy spouse and financial chaos.
The bottom line is that when one spouse needs care, everything changes financially, but it doesn’t have to be a disaster. With the right plan, you can protect your home, preserve assets, and ensure both spouses are taken care of. If you’re married and don’t have a long-term care plan in place, now is the time to start, not when you’re already in crisis. Because in this situation, timing isn’t just important, it’s everything.