Paying for care
For both paths. See both paths.
- Make one free call first: Region One's 24-hour Senior Help Line, 602-264-4357.
- Medicare pays for doctors and hospice, not daily care.
- Ask the doctor for one letter: they need "substantial supervision" due to severe cognitive impairment. (The IRS, insurers and the VA ask for it.)
- Give no money or house away before free legal help. (ALTCS looks back 5 years, the VA 3.)
Who pays for what
| Cost | Medicare |
|---|---|
| Doctor visits and the 99483 care-plan visit | Part B. You pay 20% after the $283 deductible (2026). |
| A nurse at home if homebound; rehab after a hospital stay | Yes, under its rules |
| Hospice | $0, up to $5 a prescription. Not room and board. |
| Respite for you | Through GUIDE or hospice |
| Daily help, assisted living, memory care, long nursing home stays, paying family | No |
| Cost | ALTCS (Medicaid) | VA | You |
|---|---|---|---|
| Daily help, assisted living, memory care, nursing homes | Yes, once approved | Aid and Attendance | Yes, or long-term care insurance |
| Respite for you | Up to 600 hours a year | Yes | Free: Region One, Lifespan Respite |
| Paying a family member | Yes | Some programs | Yes |
VA Aid and Attendance
What: a monthly pension for wartime veterans and surviving spouses, more when they need another person's help.
Why families use it: cash for any caregiver or place. Care costs come off their income; the VA pays the gap up to the maximum. With a clinician's letter, home care and memory care can count.
Pros: a free accredited VSO files it.
Cons: wartime service, and age 65 or a disability. Savings plus a year's income under $163,699, not counting home and car. A 3-year look-back at gifts. Walk away from anyone who charges to file, or says to move money into a trust or annuity.
Federal tax breaks
- Care counts as a medical expense with a practitioner's note from the last 12 months ("substantial supervision" due to severe cognitive impairment) and a plan of care. (Hands-on aide care counts, not housework.)
- A parent's care bills you pay count too, if you give over half their support, even if their income is too high to claim them.
- Only costs above 7.5% of adjusted gross income count, and only if you itemize. (2026 standard deduction: $32,200 married, $16,100 single. No help unless you owe federal tax. IRS Publication 502.)
Insurance you may already have
| Policy | What | Pros | Cons |
|---|---|---|---|
| Long-term care insurance (NAIC guide) | Pays toward care at home or a facility | Tax-free, up to $430 a day in 2026 | You pay the first 20 to 100 days |
| Life insurance (NAIC guide) | Cash now: accelerated death benefit, or selling it | Often tax-free if terminally or chronically ill | Below the death benefit; can count against ALTCS |
Worth knowing: Arizona policies cannot require more than "supervision or verbal cueing" for dementia. Most do not pay family caregivers.
An Arizona Partnership policy shields a dollar of savings from ALTCS for each dollar it pays.
Name a second person for late-bill notices. (In Arizona, a policy lapsed through memory loss must be restored if asked within 5 months, with back premiums.)
The house: loans, deeds and gifts
What: a loan against the home for owners 62 and older who live there. No monthly payment; the debt grows. Pros: you never owe more than the home is worth.
Cons: up to $6,000 to set up, closing costs, 2% up front and 0.5% a year for insurance. It usually comes due after over 12 months in a care facility, unless a co-borrower lives there.
Ask a HUD-approved counselor first (required): 800-569-4287. CFPB guide.
| Option | How it works | ALTCS | Taxes for heirs |
|---|---|---|---|
| Beneficiary deed (A.R.S. 33-405) | Recorded before death; passes to named people | Usually safe from payback: skips probate | If sold, taxed only on gain after death |
| Giving the house to family | A deed change counts as a gift | 5-year look-back: months without long-term care | If sold, taxed on all gain since purchase |
| "Lady Bird deed" | Not Arizona law | ||
Worth knowing: with a beneficiary deed, the owner can still sell, borrow or cancel.
Giving a daughter a $150,000 home can mean 30 months without long-term care. A spouse or disabled child is exempt.
Beneficiary deed gaps: a lien AHCCCS may record after 90 days in a nursing home, with no return expected, stays on the house. How a lien AHCCCS records after a death meets a deeded house is not settled.
ALTCS payback after a death
- ALTCS can claim back what it paid from a member's estate, at 55 and older. (Mostly a monthly plan fee that can top $8,900, care or not. AHCCCS tells home-care families to weigh paying privately.)
- No payback while a spouse, a child under 21, or a blind or disabled child survives.
- A claim letter? Act within 30 days. (Hardship waiver: 602-345-1466. AHCCCS brochure.)
Paying a family member
| Program | Who can be paid | Rules |
|---|---|---|
| ALTCS attendant care | A child, grandchild, sibling or in-law. A spouse, up to 40 hours a week. | Through an ALTCS agency, once approved. Spouse: only care beyond usual help; not self-directed. |
| Lifespan Respite, 888-737-7494 | A worker you choose, not a spouse, child, parent, guardian or housemate | Pays you back. You must live with the person, who cannot be left alone. |
| VA Veteran-Directed Care | Workers who "might include their own family member or neighbor" | A budget for the veteran |
If it's just you: a friend, a neighbor or someone from church can be the paid respite worker.
GUIDE respite: use it before hospice
- Original Medicare, living at home? Ask a GUIDE program for respite. (Up to $2,500 a year, free, with a care navigator and 24-hour line. Hospice ends it.)
- Not for Medicare Advantage, memory care units or long nursing home stays. (Assisted living: no respite money.)
- Call Hospice of the Valley, 602-636-6363, or Banner, 623-832-6500.
- Arizona has no PACE program. (Nearest thing: ALTCS home care plus GUIDE.)
Free help lines
| Who | Phone | What for |
|---|---|---|
| Region One Senior Help Line | 602-264-4357 | Anything, any hour. Maricopa County. |
| SHIP Arizona | 1-800-432-4040 | Medicare and savings programs |
| Arizona Senior Citizens Law Project | 602-252-6710 (Tuesdays 10 a.m. to 1 p.m.) | Legal help at 60 and over, no income limit. Maricopa County. Ask about deeds. |
| Community Legal Services | 602-258-3434 (weekdays 9 a.m. to 2 p.m.) or 800-852-9075 | Legal help if money is tight. AHCCCS problems too. |
A short money plan
- This week: find the papers (Medicare card, policies, a DD-214, last year's tax return). Start a care-cost log: receipts, aide hours, facility statements.
- Before a move: if married, the first month of long-term care sets the at-home spouse's savings share; plan it with legal help.
Our biases, out loud: we lean on government pages and are not lawyers or tax preparers. The AI assistant that helped research this leans toward establishment sources and hedged wording.
Checked 14 October 2026. Figures change every year. Sources.