Does Medicare Cover Long-Term Care?

The short answer is no. Medicare does not cover long-term care, also known as custodial care, if that is the only care you need. Whether you are on Traditional Medicare or a Medicare Advantage plan, the rules are the same: Medicare pays for medical care, not for help with daily living activities like bathing, dressing, or eating.

If you need to stay in a nursing home or assisted living facility purely for custodial care, you will have to pay out of pocket, use long-term care insurance, or qualify for Medicaid. Medicare is designed to fix you when you're broken, not to maintain you when you're aging.

However, Medicare does cover skilled nursing care in a certified skilled nursing facility (SNF) for a limited time, but only if it follows a qualifying hospital stay of at least three days and your doctor decides you need daily skilled care like physical therapy or intravenous injections.

We believe in straight answers, no surprises. The paper promises of some insurance commercials might make you think everything is covered, but when it comes to long-term care, you need to know the facts so you can protect what you've earned. You're the one who has to write the check if you're not prepared.

Let's break down exactly what Medicare will and won't pay for when it comes to facility care.

What Medicare Covers (Skilled Nursing Facility Care):

If you meet the strict requirements (a 3-day inpatient hospital stay and a need for daily skilled care), Traditional Medicare Part A covers:

• Days 1-20: $0 copay
• Days 21-100: A daily coinsurance [as of 2024, varies by year]
• Days 101 and beyond: You pay all costs

If you have a Medicare Supplement (Medigap) plan, it can help cover that daily coinsurance for days 21-100. Remember, the supplement decision comes AFTER you choose Traditional Medicare - it's a component of the Traditional path, not an alternative to Advantage. If you choose the Traditional path, a supplement fills the gaps by law.

What Medicare Does NOT Cover (Custodial Care):

Medicare will not pay for:

• Room and board in an assisted living facility
• Long-term stays in a nursing home for custodial care
• Adult day care
• 24-hour care at home

If you choose a Medicare Advantage plan, you are still bound by Medicare's rules on long-term care. While some Advantage plans might offer minor perks like a few meals delivered after a hospital stay or limited in-home support services, they do not cover long-term custodial care in a facility. Medsup vs MA is a rigged comparison; the real choice is Traditional Medicare (A+B) vs Medicare Advantage. Neither path covers long-term care.

Planning for long-term care is a serious business. You need to know your options before a crisis hits. We can walk you through every option for your Medicare coverage so you know exactly what you're getting.