Paying for Care · A Pillar Guide from Preferred Care at Home
Most families learn the truth at the worst possible moment: Medicare covers the follow-up visit, not the months or years of daily supervision that dementia care becomes. This guide walks through what Tennessee CHOICES, VA Aid and Attendance, Social Security, and private pay actually cover — and the order in which families in Sumner, Davidson, and Wilson counties should apply.
Medicare.gov states it plainly: long-term care is “Not Covered,” and “You pay all costs.” That single line explains most of the confusion families run into after a diagnosis. Here is what each payer actually answers.
Real things — but episode-triggered ones: inpatient hospital care, a limited stretch of skilled nursing days after a qualifying stay, hospice, and time-limited home health. None fund ongoing supervision month after month.
Yes — it’s where most Tennessee families find their real long-term care answer. Groups 1–2 require nursing facility level of care; Group 3 serves people who need support to delay or prevent reaching it.
The 2026 VA net worth limit for a Veterans Pension is $163,699. With Aid and Attendance added, the Maximum Annual Pension Rate reaches $29,093 for a veteran with no dependents, or $34,488 with one dependent.
Order matters more than families realize. VA look-backs, Medicaid timing, and asset positioning interact — and moving in the wrong sequence can cost months of eligibility or an outright penalty.
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For TennCare-eligible families, CHOICES funds personal care, homemaker services, adult day, and respite at home — not just in a facility. Group 3 is the pathway many families miss entirely: built for seniors who don’t yet need nursing home level of care but need support to delay it. Enrollment runs through TennCare Connect and your MCO.
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Confirm status, gather income and medical documentation, file VA Form 21-2680, confirm no disqualifying transfers within three years (penalties can run up to five), and work with a Veterans Service Officer or the local VA CCN team to file correctly.
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Where public programs don’t fit yet — or while applications process — families bridge with savings, home equity, life-insurance accelerated benefits, LTC insurance purchased before the need, and documented family cost-sharing. A financial professional who understands elder care can surface funds families didn’t realize could be redirected.
The CareScout 2025 Cost of Care Survey puts non-medical in-home care at a national median of $35 an hour, and assisted living at $6,200 a month. Running those numbers side by side is what helps families see where their hours and dollars actually need to go.
Personal savings and retirement withdrawals, home equity via reverse mortgage, life insurance accelerated death benefits or settlements, LTC insurance purchased before the need arose, and family cost-sharing arrangements documented in writing.
Private insurance and retiree health coverage rarely cover memory care expenses — most retirement plans were built to fund living costs, not specialized dementia support. Medigap doesn’t cover custodial care either; only LTC policies and some hybrid life-insurance riders do.
Calling free counselors first — before selling a home or moving money — keeps families from making an irreversible decision they didn’t need to make.
Free Medicare counseling at 1-877-801-0044 before making any changes — and the AAAD at 1-866-836-6678 for local resource routing.
Via TennCare Connect; current members contact their managed care organization, since MCO care coordination shapes what gets approved.
VA Form 21-2680 for Aid & Attendance — after confirming no disqualifying transfers in the past three years.
If income, age, or diagnosis warrant it — the SSA lists Young-Onset Alzheimer’s as a Compassionate Allowance for faster SSDI review.
Map hours and cost with a local in-home provider before committing to a residential move — the comparison usually changes the decision.
Preferred Care at Home of Hendersonville is a Certified Preferred Provider — a status earned through training that covers exactly this kind of payer-coordination work — serving Sumner, Davidson, and Wilson counties.
Sumner County and the neighboring Fort Campbell corridor carry a meaningful veteran and active-duty population. We participate in the VA Care Community Care Network and see Aid & Attendance payment questions up close.
We’re often the first call for families sorting out what’s realistic — mapping hours and cost with a local provider before committing to a residential move is the step that keeps options open.
Hospital care, limited skilled nursing after a qualifying stay, hospice, and time-limited home health. No long-term custodial dementia care — per Medicare.gov, you pay all costs for that category.
Personal care, adult day, respite, and homemaker services for TennCare-eligible members, with hour caps by group. Group 3 supports people before they reach nursing home level of care.
Care costs above the base pension — up to $29,093/yr with no dependents or $34,488 with one, under the $163,699 net worth limit (2026). Watch the three-year transfer look-back.
LTC policies cover in-home or facility care per policy terms — if purchased before the need, with elimination periods and benefit caps. Private pay covers anything, at a national median of $35/hour in-home.
Each covered item is triggered by a medical episode. None of them fund the ongoing supervision and daily living help that dementia care actually becomes. Here is the split, plainly.
Most Tennessee families combine two or three payers: Medicare for short-term medical episodes, Tennessee Medicaid CHOICES if eligible, VA Aid and Attendance for qualifying veterans, and private pay for the remainder.
It’s worth starting local before assuming any single program will cover everything — we’re often the first call for families sorting out what’s realistic.
Medicare pays for time-limited home health following a qualifying medical event, but it does not cover ongoing dementia supervision or long-term custodial care.
That distinction — medical event versus daily supervision — is the single most misunderstood part of Medicare for families new to dementia care.
Start with Tennessee CHOICES, Supplemental Security Income, and free TN SHIP counseling — public programs built for families with limited assets. The 2026 SSI federal payment is $994/month for an individual and $1,491 for a couple.
A benefits counselor can often identify eligibility a family didn’t know it had.
Yes, before. Tennessee CHOICES Group 3 is built specifically for seniors 65 and older who don’t yet qualify for nursing home level of care but need support to delay or prevent it.
Enrollment runs through TennCare Connect and the member’s MCO — and CHOICES can fund memory care at home, not just in a facility.
No. Medicare does not cover general supervision, wandering prevention, or ongoing custodial care at home — its benefits are limited to skilled medical care.
The honest answer points families toward Medicaid, VA benefits, or private pay for daily dementia in-home care.
Apply for benefits first. VA has a three-year look-back on asset transfers that can trigger a penalty of up to five years, and Medicaid has separate transfer rules. Your home is often exempt from Medicaid asset calculations while you live in it — but selling before understanding the rules can eliminate that protection.
Long-term care insurance can cover memory care — but only if the policy was purchased before the need arose. Medicare and Medigap plans do not cover long-term custodial dementia care.
Some newer hybrid life-insurance policies include LTC riders; review your contract with a financial professional before assuming what’s included.
Start with two professionals: a Tennessee elder law attorney and a VA-accredited benefits counselor, since VA look-backs, Medicaid eligibility, and Social Security rules interact case by case.
If younger-onset dementia is in the picture, the 2026 SSDI substantial gainful activity threshold is $1,690/month — an attorney can map the rules against your specific asset picture.
Order matters: the wrong sequence can cost months of eligibility or an outright penalty.
Talk it through with our Hendersonville team, and with TN SHIP’s free counselors at 1-877-801-0044.
