Elder Care Planning Calculator: Protect Assets, Plan for LTC

An elder care planning calculator assesses your Medicaid spend-down exposure, 5-year lookback deadline, and long-term care coverage gap. It applies the 2026 federal Medicaid figures — Community Spouse Resource Allowance $32,532-$162,660, MMMNA minimum $2,644, institutional income cap $2,982/month — and returns a plan tways with cost bands: Medicaid Asset Protection Trust $3,000-$6,000, third-party Special Needs Trust $2,500-$5,000, LTC insurance premiums by age.

Under 42 U.S.C. §1396p(c), Medicaid reviews all asset transfers made within 60 months before your application. Uncompensated transfers (including gifts to family, funding an irrevocable trust) trigger a penalty period equal to the transferred amount divided by the state's monthly divisor (California $14,440/month in 2026, Texas $7,900, Florida $10,645). A $200,000 transfer in California creates a ~14-month ineligibility period. Fund a MAPT more than 5 years before application and the lookback fully closes.

When one spouse enters a nursing home while the other remains in the community, federal spousal-impoverishment rules under 42 U.S.C. §1924 protect assets for the community spouse. The 2026 CSRA range is $32,532 minimum to $162,660 maximum (CMS CIB 12/9/2025). The community spouse can keep half the couple's countable assets up to the maximum, plus a minimum $2,644/month income allowance (MMMNA). Assets above the CSRA must be spent down before the institutional spouse qualifies for Medicaid.

No — Medicare does NOT cover long-term custodial care. Medicare covers up to 100 days of skilled nursing after a qualifying 3-day inpatient hospital stay: days 1-20 fully covered, days 21-100 with a $217/day patient coinsurance in 2026, day 101+ is 100% patient responsibility until Medicaid qualifies or private funds run out. Private-pay nursing home costs are $114,975/year semi-private (national median, CareScout 2025). This is why long-term care insurance, MAPT planning, or spend-down strategy matters.

A Medicaid Asset Protection Trust (MAPT) is an irrevocable trust designed to remove assets from your countable Medicaid pool while allowing you to receive limited benefits (typically income, sometimes limited access). Attorney-drafted: $3,000-$6,000. Because it's irrevocable, transfers into a MAPT trigger the 5-year lookback under 42 U.S.C. §1396p(c) — fund it 5+ years before Medicaid application and it fully shields the assets. Fund it within 5 years and you face a penalty period. This is why MAPT planning starts in the mid-50s to early 60s.

National median costs from the CareScout 2025 Cost of Care Survey: home health aide $34/hour ($77,792/year full-time), adult day care $95/day, assisted living $6,200/month ($74,400/year), nursing home semi-private $315/day ($114,975/year), private $355/day ($129,575/year). State variation is dramatic: Alaska tops $330,000/year for nursing home care, while Texas is $65,700/year. See the long-term care cost calculator for your specific state and care type.

VA Aid & Attendance is an increased monthly benefit added on top of the VA Veterans Pension (or Survivors Pension) for wartime veterans and surviving spouses who need help with daily activities, are substantially bedridden, or reside in a nursing home. It isn't a standalone benefit — you must first qualify for the underlying pension, which has its own net-worth and income limits set annually by the VA. Unreimbursed recurring care costs (assisted living, in-home aides) are deducted from countable income for the pension test, which is why many veterans who look over-income on paper still qualify. Current rates and the net-worth limit are published on va.gov and change every December; apply with VA Form 21-2680.

PACE (Program of All-Inclusive Care for the Elderly) is a joint Medicare/Medicaid program for people 55 or older who need a nursing-home level of care but can still live safely in the community. A PACE team provides medical care, adult day care, meals, therapy, and transportation, financed through a capped monthly payment instead of fee-for-service billing. It primarily serves people dually eligible for Medicare and Medicaid, though Medicaid-only enrollees can also qualify. PACE doesn't replace Medicaid planning — by keeping someone at home under a Medicaid-funded care plan, it can reduce or delay the need for institutional Medicaid, which changes how urgently a MAPT or spend-down strategy needs to be in place. Availability is local; not every county has a PACE program.