How to Protect Your Assets from Nursing Home Costs

As you or your parents get older, it’s natural to start thinking about the future and the financial impact of long-term care. Many people worry that nursing home costs and medical expenses could affect their life savings and the legacy they want to leave for their families. But by familiarizing yourself with the law, you can learn how to protect assets from a nursing home and create a stable future for yourself and your loved ones.

Why protect assets from nursing home costs and Medicaid?

Protecting assets from nursing home costs isn’t about avoiding the costs of care—rather, it’s about legally preserving your assets according to your wishes. According to the National Council on Aging, the average cost of a private nursing home room in the U.S. is just over $9,700 per month—or more than $100,000 per year—and it’s only expected to rise.

Many people rely on Medicaid benefits for long-term care, but Medicaid has strict asset eligibility limits, and you may have to "spend down" your assets to qualify. The Medicaid system also has a five-year "look-back" period that's designed to keep applicants from giving assets away or selling them at less than fair market value in order to qualify. That’s why many of these strategies for protecting assets from nursing home costs require advance planning—as in, at least five years before you'll need nursing home care.

6 ways to protect assets from nursing home costs

There are several strategies you can use to protect assets from nursing home costs. Here are some of the most effective ways to afford the end-of-life care you or your loved ones need.

1. Purchase long-term care insurance

Long-term care (LTC) insurance covers the cost of a nursing home, assisted living facility, adult day care, or home health care for people who are unable to take care of themselves. With an LTC plan in place, you’ll have a way to pay nursing home care costs without emptying out your savings account.

There's a price for that coverage, though. "The cost of long-term care insurance has gone up dramatically and many people hesitate to purchase a product which is available if they need it, but much like term life insurance, has no cash value if they do not need to go into a nursing home," says elder law attorney Steven Weisman.

When purchasing this protection, keep in mind that the Department of Health and Human Services says 22 percent of adults will need care for more than five years. Only 12% will need care for less than a year. Long-term care needs can add up, making LTC insurance worth it.

2. Purchase a Medicaid-compliant annuity

A Medicaid-compliant annuity is a special type of annuity that helps protect assets by turning them into regular monthly income payments that Medicaid can’t count against you. Both individuals and married couples can purchase these annuities, but they’re especially relevant for married couples when there's a healthy spouse who isn't institutionalized. 

If a couple has assets that would disqualify the applicant spouse from Medicaid, they can invest those funds into a Medicaid-compliant annuity to create a monthly income stream for the healthy spouse. When properly structured, it's a way to "spend down" and reduce the income Medicaid considers when deciding if you qualify for that assistance. 

"Annuity purchasers are effectively giving a lump sum of money to an annuity company in exchange for equal amounts of monthly payments to a healthy spouse while the other unhealthy spouse is receiving medical assistance subsidized by Medicaid," explains Shawn Plummer, CEO of The Annuity Expert.

People tend to make this purchase when they're in a last-minute or crisis planning situation, notes Plummer. However, not all annuities are Medicaid-compliant, and those that are have specific requirements, such as being non-transferable, irrevocable, and set to pay out over your life expectancy. It’s important not to rush into an annuity, and consult with an elder law attorney who understands Medicaid rules.

3. Form a life estate

Wondering how to avoid a nursing home taking your house? A life estate is a legal arrangement that allows a homeowner to transfer ownership of their primary residence to another person (usually a family member) while also remaining an owner until they die, even if death occurs in a nursing home. It protects the home from being counted as an asset for Medicaid purposes, so you get more coverage for nursing home costs.

With a life estate, "The home passes to the 'remainderman,' who is the person listed on the deed as the person to inherit the property upon the death of the 'life tenant,'" says Weisman. He adds that it differs from a joint tenancy in that until the homeowner dies, the "remainderman" has no interest in the property.

4. Put your assets in an irrevocable trust

An irrevocable trust is a legal entity that holds and protects assets for designated beneficiaries. When you place assets in an irrevocable trust, you no longer maintain control over them directly. Instead, the assets are managed by a trustee, who can make distributions according to the trust’s terms. You can put your home, business, investments, and other assets into the trust. You can even put your life insurance death benefit into an irrevocable life insurance trust (ILIT).

Because the trust owns the assets, not you, the assets aren't counted as a resource toward Medicaid eligibility. They also offer better asset protection from creditors, minimizing the chance they’ll be used for nursing home costs—that’s why an irrevocable trust is also sometimes called an asset protection trust.

The downside of an irrevocable trust is that, unlike a revocable trust, it doesn't allow you to make changes or cancel the trust except under certain circumstances. "Assets placed in the trust are legally no longer yours, and you must name an independent trustee," says Certified Estate Planner Chuck Czajka, founder of Macro Money Concepts. Also keep in mind that the five-year Medicaid lookback period applies, so you’ll need to plan well before you or your loved ones need to enter a nursing home.

With an asset protection trust, you’re revoking your rights to the assets, so consider this option carefully. Trusts can be complicated legal documents, so it’s best to work with an elder law attorney, estate planning attorney, or professional trust service like LegalZoom to be sure it’s set up correctly.

5. Consider financial gifts to family members

Making financial gifts to family members is a popular asset protection plan. The IRS allows you to gift $18,000 per person each year without having to pay the federal gift tax.

By gradually transferring wealth through gifts, you can reduce the size of your estate, which may help with Medicaid eligibility down the line. The more Medicaid benefits you receive, the more nursing home costs will be covered when you need care, and the better asset protection you’ll have.

Keep in mind that Medicaid’s five-year look-back period applies to gifts, so any gifts made within five years of applying for Medicaid could result in penalties. If you’re considering this asset protection strategy, start planning as early as possible, and keep detailed records of any gifts.

6. Start saving statements and get expert advice

If you want to protect assets from nursing home costs, don't wait to take action. The documentation required for spending during the five-year lookback period means you will need to keep bank records and receipts for large expenses, including financial gifts. 

Keep a clear record of your financial history to make the Medicaid application process smoother. Also, keep a thorough list of all your assets—including your life insurance company, investments, and titles to homes and vehicles—in case you want to create a trust.

Finally, be certain to consult an elder law attorney or estate planning attorney. They will help you understand the best options and strategies for your life stage and assets, whether you want to learn how to protect parents’ assets from a nursing home or your own. They’ll also help you navigate complex Medicaid rules, set up trusts, and make sure all your documents are in order. 

Taking a proactive approach to protecting assets from nursing home costs makes a big difference in your success—and your peace of mind.

FAQs

Does a trust protect assets from a nursing home?

Yes, certain types of trusts, like irrevocable trusts, can protect assets from nursing home costs. By placing your assets in an irrevocable trust, you remove them from your direct ownership, so it’s more difficult for creditors to claim them. It can also help reduce the size of your estate for Medicaid purposes.

What is the Medicaid look-back period?

The Medicaid look-back period is a five-year timeframe during which Medicaid reviews your financial history for any large transfers or gifts. If you’ve given away money or assets within this period, Medicaid may delay your eligibility for benefits. The penalty period is based on the value of the transferred assets, so you’ll want to plan ahead to avoid major transfers within five years of applying.

What types of assets are exempt from Medicaid eligibility calculations?

Medicaid exempts certain assets when it calculates the size of your estate to determine your eligibility for benefits. Typically, your primary residence, one vehicle, household goods, personal belongings like clothing or jewelry, certain life insurance policies, and some burial funds are not counted. Retirement accounts may also be exempt, depending on the state and whether you’re drawing income from them. Asset exemption rules vary by state, so you should consult an estate planning or elder law attorney.

How do you avoid a nursing home taking your house?

To protect your house from nursing home care costs, consider transferring it to an irrevocable trust or creating a life estate. An irrevocable trust removes your ownership, and a life estate allows you to transfer the house to a family member while keeping the right to live there. Both strategies require advance planning due to Medicaid’s five-year look-back period. Consulting an elder law or estate planning attorney can help you decide the best option for your situation.

How do spousal protection rules help preserve assets for a healthy spouse?

Medicaid has rules in place to protect the healthy spouse—known as the "community spouse”—when the other spouse requires nursing home care. These rules allow the community spouse to keep certain assets, including a portion of the couple’s combined assets, the primary home, and some income. This helps ensure the healthy spouse isn’t left without resources while the other spouse receives care. Spousal asset protection rules vary by state, so working with a professional can help you understand what’s allowed in your situation.

Sandra Beckwith contributed to this article.