Key Takeaways:

• Medicare helps cover some long-term care expenses, but it has strict limitations. It typically pays for skilled nursing facility stays, home health care, and hospice care under certain conditions.

• Medicare does not cover most custodial care, assisted living, or long-term stays in nursing homes, meaning you may need additional planning for these expenses.

How Medicare Can Help Cover Long-Term Care Costs

Long-term care is one of the biggest financial concerns for many older adults, and you might be wondering whether Medicare will help cover those expenses. While Medicare does provide some benefits related to long-term care, it does not cover everything. Understanding what is and isn’t included can help you plan ahead and avoid unexpected out-of-pocket costs.

1. Skilled Nursing Facility (SNF) Care Coverage

If you need short-term rehabilitation or skilled nursing care following a hospital stay, Medicare Part A can help cover the costs. However, there are specific requirements:

• You must have spent at least three consecutive days in the hospital as an admitted patient.

• Your doctor must certify that you need skilled nursing care, such as physical therapy, wound care, or IV medications.

• The facility must be Medicare-approved.

Medicare covers the first 20 days in full. From days 21 to 100, you must pay a daily coinsurance amount. After 100 days, Medicare does not cover the cost, and you are responsible for all expenses.

2. Limited Home Health Care Services

Medicare will cover home health care, but only if certain conditions are met. These services include skilled nursing, physical therapy, occupational therapy, and speech-language pathology. Coverage is only available if:

• You are homebound, meaning it is extremely difficult for you to leave your home.

• A doctor certifies that you need home health care.

• You receive care from a Medicare-certified home health agency.

While Medicare covers medically necessary skilled care, it does not cover custodial care such as bathing, dressing, and meal preparation, which are essential for many people requiring long-term care.

3. Hospice Care for Terminal Illnesses

Medicare covers hospice care if you have a terminal illness and a doctor certifies that you have six months or less to live. Hospice care includes:

• Pain and symptom management

• Medical services

• Social work and counseling

• Short-term inpatient stays for symptom control

Hospice care is covered under Medicare Part A, and there are minimal out-of-pocket costs, such as small copayments for medications or respite care.

4. Limited Coverage for Medical Equipment and Supplies

If you need durable medical equipment (DME), such as wheelchairs, hospital beds, or oxygen supplies, Medicare Part B may cover 80% of the approved cost, leaving you responsible for the remaining 20% unless you have additional coverage.

What Medicare Does Not Cover for Long-Term Care

While Medicare helps with some medical aspects of long-term care, it does not pay for most custodial care, meaning assistance with daily activities like dressing, eating, and using the bathroom. Here’s what you need to plan for separately:

5. Nursing Home Care Beyond 100 Days

Medicare does not cover long-term stays in nursing homes beyond 100 days. If you need extended nursing home care, you will have to pay out of pocket unless you qualify for Medicaid or have other coverage.

6. Assisted Living Facility Costs

Medicare does not cover assisted living facilities, which provide housing, personal care, and some medical services. These costs must be paid out of pocket or through alternative coverage options.

7. Custodial Care in Any Setting

If you need custodial care—meaning help with daily activities rather than medical treatment—Medicare does not cover it, regardless of whether it is provided at home, in a nursing home, or in an assisted living facility.

8. Adult Day Care Services

Adult day care services provide supervision and activities for individuals who need assistance during the day, but Medicare does not cover these programs. If you or a loved one require this type of care, you may need to explore other financial options.

Planning for Long-Term Care Costs

Because Medicare’s coverage is limited, it’s important to plan ahead. Consider these steps:

• Review your options for additional coverage, such as Medicaid or long-term care insurance.

• Create a savings plan to cover out-of-pocket costs.

• Explore community programs that may provide assistance with caregiving and support services.

Understanding Your Coverage Can Help You Prepare for the Future

Long-term care expenses can be overwhelming, but knowing what Medicare does and doesn’t cover allows you to plan ahead. To ensure you have the right coverage for your needs, it’s best to speak with a licensed agent listed on this website who can help you explore your options and find the best solution for your situation.