Key Takeaways

• Medicare still does not cover traditional long-term care, despite increasing demand and limited personal savings among aging Americans.

• New pilot programs launched in recent years are attempting to integrate home-based and supportive care, but most are limited in reach and scope.

What Long-Term Care Actually Means

Long-term care refers to the services and support you may need over an extended period when you’re no longer able to perform daily activities independently. These services include help with:

• Bathing

• Dressing

• Eating

• Using the bathroom

• Managing medications

• Moving around safely

These are known as activities of daily living (ADLs), and they often require trained caregivers, whether in a facility, at home, or in community-based settings. Long-term care can extend over months or years, making it different from short-term skilled care following surgery or hospitalization.

Medicare’s Limited Role in Long-Term Care

As of 2025, Medicare still does not cover most long-term care services. Your Medicare coverage might pay for a short stay in a skilled nursing facility (up to 100 days), or intermittent home health services, but only under very specific conditions:

• You must have had a recent hospital stay (at least 3 days as an inpatient).

• You must need skilled nursing or therapy services.

• The care must be ordered by a physician.

• Services must be provided by a Medicare-certified facility or agency.

If your needs go beyond these conditions—for example, if you need help bathing or dressing every day, but you aren’t recovering from a hospital stay—Medicare doesn’t pay for that.

Where Medicaid Steps In

Unlike Medicare, Medicaid does cover long-term care, but only for those who meet strict income and asset limits. You may be required to spend down your savings before qualifying. Once eligible, Medicaid may pay for nursing home care and, in some states, in-home or community-based services through waiver programs.

For many people, this creates a gap: You may not be poor enough to qualify for Medicaid, but Medicare doesn’t cover your daily care needs either.

Why This Gap Exists

Medicare was created in 1965 to cover acute medical care—things like hospital visits, surgeries, and doctor appointments. Long-term care was never part of its original design. Over the years, attempts to expand Medicare into long-term care have met significant political and financial resistance.

As of now, the trust fund for Medicare Part A is projected to become insolvent within the next decade. Expanding benefits significantly without new revenue is politically difficult. Long-term care, which can be extremely expensive, remains outside Medicare’s core structure.

The Growing Need in 2025

The demand for long-term care has never been higher. In 2025:

• Over 10,000 Americans turn 65 every day.

• Nearly 70% of people age 65 and older will require long-term services and support at some point.

• Most people underestimate the cost of care, which can exceed $100,000 annually for nursing home services.

The gap between what older adults need and what Medicare covers leaves many families struggling to find affordable solutions.

New Pilot Programs: What’s Being Tested

Despite the gap, Medicare has begun testing models that bring pieces of long-term care into its structure through pilot programs. These programs are often led by the Center for Medicare and Medicaid Innovation (CMMI) and aim to determine what works at a smaller scale before wider adoption.

Some pilot efforts as of 2025 include:

1. Independence at Home Demonstration

Originally launched in 2012 and extended several times, this program pays select primary care practices to deliver home-based primary care to chronically ill patients. Results show reductions in hospitalizations and healthcare costs. As of 2025, the model is still limited to a small number of practices nationwide.

2. Home-Based Primary Care Expansion Pilots

Several Medicare Advantage and Accountable Care Organizations (ACOs) are testing home-based care coordination, focusing on delivering nursing, therapy, and personal care in the home. These pilots are often regional and still in early evaluation phases.

3. Community Health Integration Models

Some CMMI programs are testing care integration across hospitals, clinics, and community-based organizations. The goal is to combine medical services with social supports, such as transportation and nutrition assistance, to delay or prevent institutionalization.

What These Pilots Are Missing

While promising, these pilots have limitations:

• Limited Reach: Only a small percentage of Medicare beneficiaries have access.

• Eligibility Requirements: Often focused on patients with very specific medical conditions.

• Geographic Restrictions: Not available in all states or communities.

• No Guarantee of Expansion: Even successful pilots can remain stalled due to budget or legislative hurdles.

These programs are not comprehensive solutions. For the average Medicare beneficiary in 2025, long-term care still requires out-of-pocket spending, private insurance, or Medicaid.

Policy Proposals and Political Roadblocks

There have been multiple proposals in recent years to integrate long-term care into Medicare:

• Some lawmakers advocate for a new Medicare Part E to address eldercare needs.

• Others suggest expanding home care through federal funding incentives.

• Still others propose public-private partnerships that provide limited long-term care benefits.

However, resistance remains strong due to:

• The high cost of universal coverage.

• Concerns about fraud and overuse.

• The complexity of coordinating social and medical services.

In 2025, none of these proposals have gained sufficient momentum to become law.

What You Can Do Right Now

While you can’t rely on Medicare alone for long-term care, there are steps you can take to plan ahead:

• Explore long-term care insurance: Look into coverage options early, ideally before age 60.

• Use Medicare-covered services strategically: If you qualify for short-term home health or skilled nursing, take advantage.

• Coordinate with Medicaid if eligible: Understand your state’s rules and start planning for possible eligibility.

• Talk to a professional: A licensed agent listed on this website can help explain options specific to your situation.

• Consider aging-in-place strategies: Home modifications, caregiver support, and community services may extend your independence.

The Future of Long-Term Care and Medicare

While new pilot programs offer a glimpse of what Medicare-supported long-term care could look like, the reality in 2025 remains uneven and inaccessible for most. Policymakers are increasingly aware of the aging population’s needs, but meaningful reforms are still slow to arrive.

You can’t count on Medicare alone for long-term support right now. But staying informed and preparing early can help you avoid financial surprises and increase your choices as you age.

If you’re uncertain about your options, speak with a licensed agent listed on this website. They can guide you through available benefits, future projections, and supplemental strategies to help protect your health and finances.