NerdWallet’s Smart Money Podcast

Episode: Long-Term Care Costs: Medicaid vs Private Pay, Plus Talking Money While Dating
Date: February 9, 2026
Hosts: Sean Pyles, CFP® (A), Elizabeth Ayoola (B)
Featured Guests: Sarah Rathner (D, NerdWallet credit cards expert), Kate Ashford (C, Certified Senior Advisor)

Episode Overview

This episode is a two-parter addressing complex, real-world money challenges:

• Part 1: Dives into NerdWallet’s recent study on money's messy role in dating, exploring dealbreakers and strategies for honest conversations.
• Part 2: Tackles a listener’s layered question about senior living payment models, how to build a budget for long-term care, and the nuanced path from private pay to Medicaid.

The Nerds give candid, practical advice and share relatable personal and research-backed insights, all with their signature mix of expertise and empathy.

1. Talking Money While Dating: Dealbreakers, Honesty, and Making it Work

Study Highlights, Dealbreakers, and Real-World Impacts

(03:40 – 17:22)

• Credit Card Debt as a Red Flag:

  • 17% of Americans consider having any amount of credit card debt a dealbreaker (up from 10% last year).

    “More people are a little bit debt averse when it comes to finding a partner.” – Sarah Rathner [04:03]

  • But 50% have lied about their own financial situations.

• Lying About Finances:

  • The #1 dealbreaker: 54% say lying about your finances is unacceptable.

    “The biggest deal breaker of all in this study is lying about your finances. ...But 50% of Americans in a relationship have lied about their financial situation with their current partner.” – Sarah Rathner [04:09]

• Unexpected Red Flags:

  • 32% say living with roommates or family is a dealbreaker, though high-cost cities make this common.
  • “The important thing in the story is that [my husband] had his own bathroom ... that’s why I married him!” – Sarah [05:28]

• Why People Hide Purchases:

  • 18% admit to lying about purchases.
  • Many do so out of fear of judgment; 29% would break up over “unnecessary” spending.
  • Sometimes “financial infidelity” is driven by shame or emergencies (medical bills, repairs).

Navigating Money Conversations as a Couple

• Building Trust and Addressing Shame:

  • Couples should create a “judgment-free zone” to encourage honesty about finances.

    “The only way out is through. And it starts with creating a culture in your relationship where... you openly talk about money without fearing judgment from the other person.” – Sarah Rathner [09:16]

  • If money is weaponized as control, therapy may be needed.

• Financial Transparency:

  • Early, honest talks about money are crucial for healthy long-term relationships—even if 42% view it as a “red flag.”

    “You don’t have to bring your most recent tax return to your third date... but talk about money from the earliest stages.” – Sarah [16:04]

Cultural and Lifestyle Dealbreakers

(11:44 – 14:57)

• Other Common Dealbreakers:
  • Bad tipping (24%) is a big U.S. dating faux pas.
  • Expectations about paying for dates, work-life balance, and lack of savings or investments.
  • Asking to borrow money is touchy, especially early in a relationship.
  • Low credit score and not planning for the future can be concerning, but context matters.

“It’s not even just high standards…when you’re tying yourself, legally or for the long term, to another person, their ability to prepare for their future…also helps you prepare for your future together.” – Sarah [13:34]

Personal Reflections and Advice

(17:22 – 20:49)

• Would These Be Dealbreakers for You?
  • All three hosts lean toward flexibility—financial values matter, but circumstances differ.
• Best Practices for Money Conversations:
  • Start early, create safety to talk without fear, practice grace for yourself and your partner.

    “Judge others hopefully less than you judge yourself.” – Sarah [18:44]

  • You’ll never fully agree—but compromise, empathy, and clear agreements are crucial.

Personal Anecdotes

(19:38 – 20:49)

• Sarah and Elizabeth both mention relationships where mismatched financial habits contributed to endings, but money alone wasn't the only factor.
• Sean highlights the importance of equitability in relationships despite differing financial backgrounds.

2. Senior Living Care Costs: Medicaid vs. Private Pay, Building a Budget, and Tough Conversations

Listener Question (Paraphrased)

(26:40 – 28:14)

• Listener’s father-in-law needs to move closer for health reasons, possibly into assisted or independent living.
• They’re comparing monthly payment vs. buy-in models, need a budget, and want clarity on Medicaid eligibility and transition.

Understanding the Landscape: Cost and Payment Models

(28:27 – 29:27)

• Regional Pricing: Costs can range from $4,700/month (AL) to $11,600/month (HI); local variance is also important.
• Assessing Needs: Room type, care level, add-on services (memory care, assistance with daily living), and annual increases all affect cost.
  • Resource: Genworth/CareScout Cost of Care Survey (by state, type of care).

How Do People Really Afford This?

(31:00 – 32:29)

• Most use a mix of Social Security, retirement accounts, savings, home equity (selling home or reverse mortgage), some have long-term care insurance or veterans’ benefits.
• Big Myth: Medicare does not cover long-term care.
• Note on Inheritance: “Your heirs would probably tell you they would rather you live comfortably at the end of your life. So spend it.” – Kate [32:29]

Medicaid: The Safety Net and Its Complications

(32:29 – 34:49)

• To qualify, assets must be depleted—and the system checks for attempted “giveaways” (the five-year lookback).

  “Don’t try to trick the system because they’re one step ahead of you.” – Sean [32:52]

• Many seniors rely on family caregivers; only 3.5% of over-65s are in nursing homes/assisted living.

Payment Structures: Monthly vs. Buy-In Models

(35:30 – 37:14)

• Monthly: Like rent, covers base services; common for assisted living/nursing homes.

• Buy-in / CCRC: Continuing Care Retirement Communities require a large upfront deposit plus ongoing monthly fees, letting residents access increasing levels of care as needed.

• CCRCs generally want residents independent at move-in.

• Fun tangent: There’s a Jimmy Buffett-themed retirement community (Margaritaville) showing the lifestyle spectrum in senior living.

Refundable Buy-Ins and Making the Right Choice

(37:14 – 38:12)

• Refunds vary—partial/full, declining over time, or none; always read the fine print.

• Example: Kate’s grandfather got most of his buy-in back after leaving shortly post-move-in.

• Choosing Best Model:

  • Consider care needs, expected longevity, access to step-up care, and family support.
  • Use services like A Place for Mom to match needs and options.
  • Longevity is an “educated guess”:
    Average need (claims data): 2–4 years for men, 3–6 years for women, but huge individual variation.

Planning Under Uncertainty & Family Dynamics

(40:11 – 41:31)

• Model various scenarios—don’t assume averages apply.
• Start conversations early and revisit often. Normalize the topic to reduce stigma and stress.

  “If you normalize talking about it, it becomes less taboo and weird and depressing. ...Just talk about it like any financial planning topic.” – Kate [42:08]

The Medicaid Application Process: Overview and Resources

(42:23 – 44:01)

• State-Specific, Asset- and Income-Based: Rules and applications differ.
• Where to Start:
  • State Medicaid office
  • Local Office on Aging (eldercare.acl.gov)
  • MedicaidPlanningAssistance.org
  • Certified Medicaid Planners or elder law attorneys (fees vary; worth it for complex cases)
• Some facilities accept “private pay” with seamless Medicaid transition when assets run out.

“There are folks out there called certified Medicaid planners. ...I didn’t need anything beyond the free consultation, so no harm in calling.” – Kate [43:39]

Key Quotes & Memorable Moments

• On financial transparency in relationships:
  “You don’t have to bring your most recent tax return to your third date... but talk about money from the earliest stages.” – Sarah [16:04]

• On money shame and honesty:
  “The only way out is through. It starts with creating a culture in your relationship where... you openly talk about money without fearing judgment from the other person.” – Sarah [09:16]

• On spending down assets for senior care:
  “Your heirs would probably tell you they would rather you live comfortably at the end of your life. So spend it.” – Kate [32:29]

• On Medicaid planning pitfalls:
  “Don’t try to trick the system... they’re one step ahead of you.” – Sean [32:52]

• On normalizing tough conversations:
  “If you normalize talking about it, it becomes less taboo and weird and depressing. ...Just talk about it like any financial planning topic.” – Kate [42:08]

Useful Timestamps

• Talking dating dealbreakers: [03:40 – 17:22]
• No Spend/Friction Spend challenge check-in: [20:50 – 24:08]
• Listener question (senior care): [26:40 – 28:14]
• Senior living cost and payment breakdown: [28:27 – 41:31]
• Medicaid process and resources: [42:23 – 44:01]

Takeaways & Actionable Advice

For Couples:

• Start money talks early.
• Focus on underlying values and context, not just financial “scores” or red flags.
• Practice empathy—both for yourself and your partner.
• Don’t let shame stagnate honesty or growth.

For Planning Senior Care:

• Research local costs carefully—huge state and facility variation.
• Build a realistic budget using a mix of all available resources.
• Understand payment models (monthly vs. buy-in, refundability, care escalation).
• Don’t count on Medicare for long-term care (but do explore VA, LTC insurance, and family home equity).
• To qualify for Medicaid, assets must be depleted—and you can’t sidestep the lookback rules.
• Begin family conversations early and revisit regularly.

Helpful Resources Mentioned:

• Genworth/CareScout Cost of Care Survey
• A Place for Mom
• MedicaidPlanningAssistance.org
• Eldercare Locator: eldercare.acl.gov

NerdWallet’s Smart Money Podcast delivers practical, nuanced financial wisdom—whether you’re dating or gearing up for the realities of senior living.