Does Medicare Cover Long-Term Care? What Seniors Need to Know

The question “does Medicare cover long-term care” is one of the most important and most misunderstood topics in senior healthcare. The short answer is no: Medicare does not cover long-term custodial care. While Medicare pays for short-term skilled nursing and rehabilitation, it does not cover long-term care in nursing homes, assisted living facilities, or at home when the care is primarily custodial in nature. This policy guide walks through exactly where the line falls and how families pay for what Medicare will not.

This gap in coverage surprises many seniors and their families. According to the U.S. Department of Health and Human Services, roughly 70 percent of Americans turning 65 will need some form of long-term care services during their remaining years, and about one in five will need it for longer than five years. With nursing home care commonly running well over $100,000 per year and assisted living frequently exceeding $60,000 annually, understanding what Medicare does and does not cover is essential for financial planning.

What Medicare Does Cover: Short-Term Skilled Care

Medicare does provide coverage for certain types of short-term care that are sometimes confused with long-term care. Understanding the distinction is critical, because the difference between “skilled” and “custodial” care is what determines whether Medicare pays at all.

Medicare Part A: Skilled Nursing Facility (SNF) Coverage

Medicare Part A covers stays in a skilled nursing facility under specific conditions:

• Qualifying hospital stay: You generally must have been admitted as an inpatient to a hospital for at least three consecutive days (not counting the discharge day) before transferring to a SNF. Time spent under “observation status” does not count toward the three days — a common and costly trap.
• Skilled care requirement: The care must be skilled nursing or skilled therapy services that, as a practical matter, can only be provided in a SNF setting.
• Time limit: Medicare covers up to 100 days per benefit period in a SNF, and only for as long as you continue to need and receive skilled care.

The cost-sharing structure for SNF stays under Medicare Part A in 2026 is approximately as follows (Medicare updates these amounts every year, so confirm the current figures on Medicare.gov):

For context, the Medicare Part A inpatient hospital deductible in 2026 is approximately $1,736 per benefit period. Note that a “benefit period” is not a calendar year — it begins the day you are admitted and ends after you have been out of a hospital or SNF for 60 consecutive days. A new benefit period means a new deductible and a fresh 100-day SNF clock, which is why the same person can face the deductible more than once in a year.

After 100 days, Medicare stops paying entirely. This is the critical point where many families discover the limits of Medicare coverage. For more on what happens at this stage, see our guide on what happens when Medicare stops paying for nursing home care.

Medicare Home Health Services

Medicare Part A and Part B cover home health services when all of the following apply:

• You are homebound (leaving home requires a considerable and taxing effort).
• A doctor or allowed provider certifies that you need intermittent skilled nursing care, physical therapy, speech-language therapy, or continued occupational therapy.
• The care is ordered under a plan of care and provided by a Medicare-certified home health agency.

Covered home health services include part-time or intermittent skilled nursing, therapy services, medical social services, and some medical supplies. Medicare does not cover 24-hour-a-day home care, homemaker services (cooking, cleaning, shopping), or personal care assistance (bathing, dressing, toileting) when that custodial help is the only care you need.

Hospice Care

Medicare Part A also covers hospice care for beneficiaries who are certified as terminally ill (a life expectancy of six months or less if the illness runs its normal course) and who choose comfort-focused care over curative treatment. Hospice covers nursing, medications for symptom control, medical equipment, aide visits, and counseling. Importantly, hospice room and board in a nursing facility is generally still not covered — hospice pays for the comfort care, not for long-term residence.

What Medicare Does Not Cover: Long-Term Custodial Care

The core of the question “does Medicare cover long-term care” comes down to custodial care, which Medicare explicitly excludes. Custodial care includes:

• Assistance with activities of daily living (ADLs): Bathing, dressing, eating, toileting, transferring, and continence management.
• Supervision for safety: Care for individuals with dementia or cognitive impairment who need someone present to keep them safe.
• Long-term nursing home residence: Stays beyond the 100-day skilled benefit, or stays that are primarily custodial rather than skilled rehabilitation.
• Assisted living: Medicare does not cover room and board or personal care in assisted living facilities.
• Adult day care: Not covered by Medicare.
• Long-term in-home aides: Personal care aides who help with daily activities on an ongoing basis.

This means the vast majority of long-term care expenses — which can last months or years — fall entirely on the individual and their family unless other coverage or programs are in place.

How Much Does Long-Term Care Cost Without Medicare Coverage?

The costs that Medicare does not cover are substantial and have risen steadily. Figures from the Genworth/CareScout Cost of Care Survey give a sense of recent national medians, though actual prices vary widely by state, metro area, and level of care. The ranges below are rounded estimates and should be treated as ballpark planning numbers, not quotes:

For someone needing three years of nursing home care, the total cost could easily exceed $300,000. These figures underscore why planning for long-term care is a financial imperative for anyone approaching retirement age. Because costs vary so much by region, always price-check facilities in your own area rather than relying on national averages. For more details on facility costs, see our guide on how much assisted living costs.

Alternatives to Medicare for Long-Term Care Coverage

Since Medicare does not cover long-term care, seniors and their families need to explore other options for paying these costs.

Medicaid

Medicaid is the largest payer of long-term care in the United States. Unlike Medicare, Medicaid covers long-term nursing home care and many home and community-based services. However, Medicaid is a means-tested program with strict income and asset limits:

• Individuals must have very limited income and assets (countable assets are generally capped around $2,000 for an individual in most states, though the exact figure and the treatment of a home, car, and spousal assets vary by state).
• Many people must “spend down” their savings before qualifying.
• Medicaid estate recovery allows states to recoup certain costs from a deceased beneficiary’s estate.
• Not all nursing homes accept Medicaid, and Medicaid beds may have waiting lists.
• A five-year “look-back” period applies to asset transfers; gifts or transfers for less than fair value during that window can trigger a penalty period of ineligibility.

Spousal impoverishment rules exist to protect a “community spouse” (the one still living at home) from being left destitute when the other spouse enters a nursing home. Because these rules are complex and state-specific, families often consult an elder law attorney before spending down or transferring assets.

Long-Term Care Insurance

Private long-term care insurance policies cover nursing home, assisted living, and home care costs. Key considerations:

• Best purchased in your 50s or early 60s, when premiums are more affordable and you are more likely to qualify medically.
• Annual premiums vary widely and have risen over time; they depend on your age, health, the daily benefit amount, the benefit period, and any inflation protection.
• Policies have faced significant premium increases in recent years, and many traditional stand-alone insurers have exited the market.
• Hybrid policies that combine life insurance or an annuity with a long-term care benefit have become increasingly popular because they return value even if care is never needed.

Medicare Supplement (Medigap) Plans

Medigap plans help pay for Medicare cost-sharing but do not extend Medicare’s coverage to long-term custodial care. They can help cover the daily coinsurance for days 21 through 100 in a skilled nursing facility, which saves money during the Medicare-covered period but does not address long-term care beyond 100 days.

Veterans Benefits

Veterans may qualify for long-term care benefits through the VA, including nursing home care, community living centers, home-based primary care, and the Aid and Attendance pension benefit, which provides additional monthly income to help pay for care. Eligibility depends on service history, disability rating, income, and assets, so it is worth contacting the VA or an accredited veterans service officer directly.

PACE (Program of All-Inclusive Care for the Elderly)

PACE is a joint Medicare and Medicaid program available in many areas that helps older adults who need a nursing-home level of care remain living in the community. It provides coordinated medical care, adult day services, therapy, and personal care through a local PACE organization. To qualify, you generally must be 55 or older, live in a PACE service area, and be certified as needing nursing-home-level care. For those who are dual-eligible, PACE can be a valuable alternative to institutional care.

Personal Savings and Assets

Many Americans ultimately pay for long-term care out of pocket using savings, retirement accounts, home equity, or other assets. Reverse mortgages and life insurance policy conversions (life settlements) are sometimes used to fund care, though each has trade-offs and should be reviewed carefully with a financial professional.

Medicare Advantage and Long-Term Care

Medicare Advantage (Part C) plans provide the same basic benefits as Original Medicare and cannot cover long-term custodial care. However, some Medicare Advantage plans offer supplemental benefits that can help with certain long-term-care-adjacent needs:

• In-home support services: Some plans offer limited hours of personal care assistance, meal delivery, or transportation.
• Caregiver support: Certain plans include respite care or caregiver training benefits.
• Special Supplemental Benefits for the Chronically Ill (SSBCI): Medicare Advantage plans can offer additional benefits to enrollees with qualifying chronic conditions, which may include home modifications, pest control, or food assistance.

These supplemental benefits are helpful but do not replace comprehensive long-term care coverage. They are typically limited in scope and duration, and they vary considerably from plan to plan and year to year, so read the plan’s Evidence of Coverage before assuming a benefit will be there.

How to Plan for Long-Term Care Costs

Given that Medicare does not cover long-term care, proactive planning is essential. Here are practical steps:

• Assess your risk: Consider your family health history, current health status, and the likelihood of needing long-term care. Women, on average, need care longer because of longer life expectancy.
• Explore long-term care insurance early: If you are in your 50s, investigate policies while premiums are lower and you are more likely to qualify.
• Consider hybrid insurance products: Life insurance policies with long-term care riders provide coverage for care costs while preserving a death benefit if long-term care is not needed.
• Build dedicated savings: Set aside funds specifically for potential long-term care needs, separate from general retirement savings.
• Understand Medicaid planning: Consult an elder law attorney about legally structuring assets to protect a spouse while planning for potential Medicaid eligibility, keeping the five-year look-back period in mind.
• Explore home and community-based options: Home care is often less expensive than facility care. Many states offer Medicaid waiver programs that provide home-based services to individuals who would otherwise need nursing home care.

Frequently Asked Questions

Does Medicare pay for nursing home care at all?

Medicare pays for up to 100 days of skilled nursing facility care per benefit period, but only after a qualifying inpatient hospital stay and only while skilled care is needed. It does not pay for long-term custodial care in a nursing home. After 100 days, or when skilled care is no longer needed, Medicare coverage ends entirely.

Does Medicare cover assisted living?

No. Medicare does not cover room, board, or personal care in assisted living facilities. If you receive Medicare-covered services like skilled nursing or therapy while living in an assisted living facility, Medicare may pay for those specific services, but not the facility costs themselves.

At what age should I start planning for long-term care?

Financial advisors generally recommend starting to plan in your 50s, when long-term care insurance premiums are most affordable and you are most likely to qualify based on health. That said, it is never too late to begin — even if it means focusing on savings strategies and Medicaid planning rather than insurance.

Does Medicare cover home health aides for long-term care?

Medicare covers home health aides only as part of a skilled care plan when you also need skilled nursing or therapy services. It does not cover standalone personal care assistance for activities of daily living on a long-term basis. For ongoing in-home custodial care, you would need to pay out of pocket, use long-term care insurance, or qualify for Medicaid home and community-based services.

Can I use Medicare and Medicaid together for long-term care?

Yes. Individuals who qualify for both Medicare and Medicaid (known as dual-eligible beneficiaries) can have Medicare cover their medical care and short-term skilled nursing, while Medicaid covers long-term custodial care in a nursing home or community setting. Qualifying for Medicaid requires meeting income and asset limits.

What is “observation status” and why does it matter?

Hospitals sometimes classify a stay as “observation” (an outpatient category) rather than an inpatient admission. Because Medicare’s SNF benefit requires a three-day inpatient stay, time spent under observation does not count — even if you were in a hospital bed for several days. Ask directly whether you are an inpatient or under observation, because it can determine whether Medicare will pay for follow-up SNF care.

Final Takeaway

Does Medicare cover long-term care? No. Medicare covers short-term skilled nursing and rehabilitation but does not pay for the ongoing custodial care that most people associate with long-term care. With nursing home costs commonly exceeding $100,000 per year and assisted living frequently above $60,000, planning for these expenses is critical. Explore long-term care insurance, understand Medicaid eligibility rules, look into PACE and VA benefits if you qualify, and consider hybrid insurance products to protect yourself and your family. Learn more about assisted living costs and what happens when Medicare stops paying for nursing home care. For more healthcare policy information, visit our policy guide.

Sources

• Medicare.gov (CMS) — “Skilled nursing facility (SNF) care,” “Home health services,” “Hospice care,” and 2026 Part A costs (deductible and daily coinsurance)
• CMS.gov — Medicare & You handbook; Special Supplemental Benefits for the Chronically Ill (SSBCI); PACE program overview
• Medicaid.gov — long-term services and supports; estate recovery; home and community-based services waivers; spousal impoverishment rules
• U.S. Department of Health and Human Services / Administration for Community Living (LongTermCare.gov) — “How Much Care Will You Need?”
• Genworth / CareScout Cost of Care Survey — national median costs for nursing home, assisted living, home care, and adult day care
• U.S. Department of Veterans Affairs (VA) — geriatrics and extended care; Aid and Attendance pension