Does Medicare Cover Long-Term Care?

Long-term care are services that help people meet their care needs over an extended period. These services typically include assistance with daily activities such as bathing, dressing, eating, and mobility. Long-term care can also involve specialized services like nursing care or rehabilitative therapy. It is commonly provided in nursing homes, assisted living facilities, or even at home, depending on the individual's needs and the level of care required.

Medicare overview

Medicare is a federal health insurance program designed primarily for people aged 65 and older, as well as some younger individuals with disabilities. It has several parts, each covering different types of care:

• Medicare Part A covers hospital stays, skilled nursing facility care (short-term), hospice care, and limited home health care.
• Medicare Part B covers outpatient services, doctor visits, and some preventive care.
• Medicare Part C (Medicare Advantage) is an alternative plan offered by private insurers, bundling Part A and Part B benefits, often with added services.
• Medicare Part D helps cover the cost of prescription drugs.

When Medicare does provide long-term care

Medicare offers limited coverage for long-term care under very specific conditions. Typically, Medicare provides coverage for short-term care that is medically necessary after a hospital stay.

Examples include:

• Skilled Nursing Facility (SNF) care: Medicare Part A covers care in a skilled nursing facility for a limited period, typically up to 100 days, following a hospital stay of at least three days. The care must be related to a condition treated during the hospital stay and be medically necessary, such as physical therapy or wound care. Medicare covers the total cost for the first 20 days, with a daily co-payment required for days 21-100.
• Home health care: Medicare may cover some limited home health care services, such as intermittent skilled nursing care, physical therapy, or speech-language pathology, if the care is medically necessary and ordered by a doctor. This coverage is typically short-term and only provided if the person is homebound and requires skilled care, not long-term custodial care (see below).
• Hospice care: Medicare Part A covers hospice care (in the home or in a hospice facility) for those who are terminally ill and have chosen palliative care over curative treatments.

When Medicare does NOT provide long-term care

Long-term care (also called Custodial care (or "long-term services and support") includes medical and non-medical care for people who have a chronic illness or disability.

This may include:

• Personal care assistance (like help with everyday activities, including dressing, bathing, and using the bathroom) 
• Home-delivered meals
• Adult day health care
• Home and community-based services

Medicare and most other health insurance, including Medicare Supplement Insurance (Medigap), do NOT provide coverage for most of these long-term care services that people need as they age or become disabled. You might qualify for long-term care through Medicaid, or you can choose to buy private long-term care insurance.

Alternative coverage for long-term care

Since Medicare does not cover most long-term care services, you may need to explore other options for financing your or your loved one's care.

Medicaid

Medicaid is the primary payer for long-term care in the United States. Unlike Medicare, Medicaid covers both medical and non-medical care for those with low income and limited assets.

Medicaid can pay for long-term care in a nursing home, assisted living facility, or even at home through specific programs. Many states also offer Medicaid waivers—such as Home and Community-Based Services (HCBS) waivers—that allow recipients to receive long-term care in their homes or community settings rather than in institutional facilities.

Eligibility requirements and services covered under Medicaid vary by state, but Medicaid is a crucial safety net for long-term care expenses for those who qualify.

Call your State Medical Assistance (Medicaid) office to find out if you qualify for long-term care coverage through Medicaid.

Private long-term care insurance

Long-term care insurance is another option for those who want to plan ahead for future care needs. These private insurance policies are designed specifically to cover long-term care costs, including custodial care in nursing homes, assisted living facilities, and at-home care.

Policies vary in terms of the types of services covered, the duration of coverage, and the cost of premiums, which increase based on age and health conditions. Individuals who purchase long-term care insurance early can mitigate the financial burden of long-term care later in life, though policies can be expensive and may not be an option for everyone.

Call your State Insurance Department to get more information about long-term care insurance.

Other options

• Personal savings: Many rely on their own savings or retirement funds to cover long-term care costs. This option may work for those with substantial financial resources but can quickly deplete funds for others.
• Reverse mortgages: A reverse mortgage allows homeowners aged 62 and older to convert home equity into cash, which can be used to pay for long-term care services. This option can help you remain in your homes while accessing funds for your care needs, though it comes with certain risks and costs.
• Family caregiver support programs: Some states and programs compensate family members who care for a loved one. Programs like Medicaid's Structured Family Caregiving allow family caregivers to get paid for providing long-term care to eligible individuals in their homes, providing a solution for families seeking financial support while offering care.

A note from Givers

Navigating long-term care options can be complex and overwhelming. While Medicare covers certain short-term care, it often falls short for long-term needs. That’s where we come in, helping families get enrolled, paid, and supported through state Medicaid programs. Check your eligibility >>