Does Medicare Cover Long-Term Care?
Mostly, no. Medicare pays for short-term skilled care, like nursing or therapy after a hospital stay, but it doesn’t pay for ongoing help with daily activities such as bathing, dressing, or getting around when that’s the only care you need. That ongoing help is what most people mean by long-term care.
What does Medicare cover?
Medicare covers care that is medical and short-term, including:
Skilled nursing facility care: up to 100 days per benefit period, after a qualifying inpatient hospital stay of at least three days. After day 20, you pay a daily coinsurance amount. (Medicare.gov)
Home health care: part-time skilled nursing or therapy at home, if you’re homebound and a doctor certifies you need it. (Medicare.gov)
Hospice care, for people with a terminal illness.
What doesn’t Medicare cover?
Medicare doesn’t cover custodial care (help with activities of daily living like bathing, dressing, eating, using the bathroom, and moving from a bed to a chair) when that’s the only care you need. It also doesn’t cover 24-hour care at home. (Medicare.gov) The NAIC’s consumer guide advises that you should not count on Medicare to pay your long-term care costs. (NAIC Shopper’s Guide)
Custodial care is the help people need when they can no longer fully manage on their own, and it can continue for months or years.
Why does this matter if you want to stay home?
Most long-term care happens at home, not in a facility. (LongTermCare.gov) The help people typically need at home (assistance with bathing, meals, or getting around) is exactly the kind of care Medicare doesn’t pay for.
Someone turning 65 today has almost a 70% chance of needing some type of long-term care services in their remaining years, according to the Administration for Community Living. (LongTermCare.gov)
So what does pay for long-term care?
The main options are:
Personal savings
Family members who provide care, often unpaid
Medicaid, which covers long-term care only after you’ve spent down most of your assets, see Long-Term Care Insurance vs. Medicaid
Long-term care insurance, which is purchased in advance and pays a benefit when you need care, see How Does Long-Term Care Insurance Work?
Staying Power is a licensed insurance agency that helps people plan how they’ll pay for the care Medicare doesn’t cover.
If you’re weighing how you’d pay for care, get started to see what care costs and how to fund it. It takes a few minutes.
Frequently asked questions
Does Medigap cover long-term care?
No. Medicare Supplement (Medigap) plans help pay your share of costs for services Medicare already covers. They don’t cover long-term custodial care.
Does Medicare Advantage cover long-term care?
Medicare Advantage plans generally don’t cover long-term custodial care. Some plans offer limited extra benefits, so check your plan’s coverage documents.
How long will Medicare pay for a nursing home?
Medicare covers up to 100 days of skilled nursing facility care per benefit period, after a qualifying hospital stay, and only while you need daily skilled care. It doesn’t pay for long-term custodial care in a nursing home.
