Medicare has strict limits on long-term care coverage

Medicare covers some short-term skilled care after a hospital stay, but it does not cover the ongoing personal care and living information that makes up most long-term care. If you need help with bathing, dressing, meals, or medication reminders for months or years, Medicare will not pay for it. You will need to look at other sources: Medicaid, private long-term care insurance, your own savings, or family support.

The confusion happens because Medicare does cover nursing home stays and home health visits — but only under specific conditions and only for a limited time. Understanding those conditions and time limits is the difference between knowing what to expect and facing a sudden bill you did not plan for.

Key Takeaways

  • Medicare covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, but only if you need daily skilled nursing or rehabilitation.
  • You pay nothing for days 1–20, a daily copay for days 21–100, and all costs after day 100.
  • Medicare covers home health visits only if a doctor orders them, you are homebound, and the care is skilled (wound care, physical therapy, injections) — not personal care like bathing or meal prep.
  • Medicaid, not Medicare, is the program that pays for long-term custodial care in nursing homes or at home for people with limited income and assets.
  • If you think you will need long-term care, talk to your doctor and a financial advisor now about private insurance, savings, or Medicaid planning.

What Medicare covers in a nursing home

Medicare covers a skilled nursing facility (SNF) stay only after you have been in a hospital for at least three consecutive days. The stay must be for the same condition you were hospitalized for, or a related one. You cannot go directly from home to a nursing home and have Medicare pay.

Once you meet that requirement, Medicare covers up to 100 days per benefit period. A benefit period starts the day you enter the hospital and ends 60 days after you leave the nursing home. During those 100 days, you pay nothing for the first 20 days. From day 21 to day 100, you pay a daily copay (the amount changes each year; check your Medicare summary for the current figure). After day 100, you pay the full cost yourself.

The nursing home must be certified by Medicare, and the care you receive must be skilled care — meaning it requires a nurse or therapist. Physical therapy after a hip replacement, wound care after surgery, or intravenous antibiotics count. Custodial care — help with bathing, dressing, toileting, or meals — does not, even if a nurse is present.

What Medicare covers for home health care

Medicare covers home health visits if three things are all true: your doctor has ordered the care, you are homebound (leaving home is difficult and requires help), and the care is skilled. Skilled home health means a nurse, physical therapist, occupational therapist, or speech therapist is doing the work — not a home health aide.

Covered services include wound dressing, catheter care, physical therapy, occupational therapy, speech therapy, and injections. Uncovered services include bathing, grooming, meal preparation, housekeeping, and medication reminders, even if a home health aide provides them. If you need only personal care and no skilled services, Medicare does not pay.

There is no time limit on home health coverage as long as your doctor continues to order it and you continue to need skilled care. However, Medicare reviews your case regularly. If you stop improving or no longer need skilled care, Medicare will stop paying.

What Medicare does not cover

Medicare does not cover custodial care — the day-to-day help most people think of as long-term care. This includes bathing, dressing, toileting, eating, medication reminders, and supervision. It does not matter how long you need it or how much it costs; Medicare will not pay.

Medicare also does not cover care in an assisted living facility, adult day care, or continuing care retirement communities. It does not cover the room and board portion of a nursing home stay, only the skilled nursing care itself. If you stay in a nursing home beyond the 100 days Medicare covers, you pay for everything — the room, the meals, the staff, all of it.

Respite care (temporary care to give a family caregiver a break) is not covered. Neither is care ordered by a doctor but not considered medically necessary by Medicare's standards. If Medicare denies a claim, you have the right to appeal, but the initial decision rests with Medicare, not your doctor.

How Medicaid covers long-term care differently

Medicaid is a separate program from Medicare, run by states with federal money. Unlike Medicare, Medicaid does cover custodial care in nursing homes and at home — the kind of ongoing personal care that Medicare will not touch. Medicaid pays for bathing, dressing, meals, and supervision for as long as you need it.

The catch is that Medicaid is means-tested. You must have limited income and very limited assets to may have access to. The asset limit varies by state but is typically around $2,000 for a single person. A home you live in usually does not count against the limit, but savings, investments, and a second property do.

If you are married, the rules are more complex. The spouse who is not in the nursing home (called the community spouse) can keep more assets and income. Each state sets these limits differently, so you will need to check your state's Medicaid office or a Medicaid planner.

Medicaid planning — arranging your finances so you may have access to for Medicaid without losing everything — is legal and common, but it requires informed help. An elder law attorney or certified financial planner who specializes in Medicaid can explain your options.

Private long-term care insurance as an alternative

Some people buy long-term care insurance before they need care. This is a separate insurance policy (not part of Medicare or Medicaid) that pays a daily benefit toward nursing home care, assisted living, or home care. The benefit amount, length of coverage, and cost depend on the policy you choose.

Long-term care insurance is most affordable if you buy it in your 50s or early 60s, before health problems make you uninsurable. If you wait until you are older or already have a chronic illness, premiums rise sharply or you may not be able to buy a policy at all. Some policies also increase in cost over time, so what seems affordable at 60 may become unaffordable at 75.

Not everyone needs long-term care insurance. If you have substantial savings, a family willing and able to provide care, or you are comfortable with the idea of spending down your assets and then using Medicaid, insurance may not be worth the cost. A financial advisor can help you decide based on your health, family history, and finances.

Questions to ask your doctor and Medicare

If you are facing a hospital stay or think you might need long-term care soon, ask your doctor these questions: Will I need skilled care after I leave the hospital? For how long? Will I be able to go home, or will I need a nursing home? If I go home, will I need home health visits?

Call Medicare directly at 1-800-MEDICARE (1-800-633-4227) to ask about your specific situation. You can also log into your Medicare account at Medicare.gov to see what your coverage is and what you will owe. If you receive a bill you think is wrong, ask for an explanation and do not pay it until you understand why.

If you are thinking ahead and want to plan for long-term care, talk to an elder law attorney or a certified financial planner. These conversations are most useful before you are in crisis, when you have time to explore options and make decisions that fit your values and finances.

Frequently Asked Questions

If I need a nursing home for more than 100 days, who pays?

You pay out of pocket, or Medicaid pays if you may have access to. Some people use a combination: Medicare covers the first 100 days, then they pay privately until their savings run out, then Medicaid takes over. This is called "spending down." Talk to a Medicaid planner about whether this strategy makes sense for you.

Does Medicare cover memory care or assisted living?

No. Medicare does not cover assisted living facilities or memory care units. These are custodial care settings, and Medicare does not pay for custodial care anywhere — not in a nursing home, not at home, not in an assisted living facility. Medicaid may cover some of these costs in some states, but rules vary widely.

Can I use Medicare to pay for a home health aide to help me bathe and dress?

Not unless the aide is there to help a nurse or therapist with skilled care. If you need only personal care (bathing, dressing, meals), Medicare will not pay for a home health aide. You would need to pay privately, use Medicaid if you may have access to, or rely on family or friends.

What happens if my doctor says I need care but Medicare says it is not medically necessary?

You have the right to appeal. Ask Medicare for a detailed explanation of why they denied the claim, then work with your doctor to provide more information. If you disagree with the appeal decision, you can request a hearing. An elder law attorney or patient advocate can help you through this process.

Is there a way to plan ahead so I do not lose my savings if I need long-term care?

Yes, but it depends on your situation. Options include buying long-term care insurance while you are young and healthy, setting up certain trusts, or working with a Medicaid planner to understand how your state's rules work. An elder law attorney can explain which strategies are legal and right for you.