Medicare covers some long-term care costs, but not most of them — and the limits are strict
Medicare pays for skilled nursing care and some home health services, but only under specific conditions and for limited time periods. It does not pay for custodial care — help with daily activities like bathing, dressing, or meal preparation — which is what most people need in a long-term care setting. If you need ongoing information with activities of daily living, you will need to pay out of pocket, use Medicaid, or have a long-term care insurance policy.
The difference matters because it shapes your actual costs. A nursing home stay that Medicare covers might last 100 days. After that, you pay the full bill yourself unless you have another source of funding. Understanding what Medicare does and does not cover helps you plan ahead and know what to expect.
Key Takeaways
- Medicare Part A covers up to 100 days in a skilled nursing facility after a hospital stay of at least three days, but only for skilled care — not custodial care or room and board.
- You pay nothing for days 1–20, a daily coinsurance amount for days 21–100, and the full cost after day 100.
- Medicare Part A also covers some home health services if you are homebound and need skilled care ordered by your doctor, with no time limit.
- Medicaid, not Medicare, is the primary payer for long-term custodial care in nursing homes and assisted living, but you must meet income and asset limits.
- Long-term care insurance, purchased before you need care, can cover costs Medicare does not — but premiums and may be able to access depend on your age and health when you buy.
What Medicare Part A Covers in a Nursing Home
Medicare Part A covers a stay in a skilled nursing facility (SNF) for up to 100 days, but only if you meet three conditions: you were hospitalized for at least three consecutive days when ready before admission, you are admitted within 30 days of hospital discharge, and you need daily skilled nursing or rehabilitation services — not just help with daily living tasks.
Skilled care means services that require a nurse or therapist: wound care, intravenous medications, physical therapy after a hip fracture, or speech therapy after a stroke. If you are in a nursing home mainly because you cannot bathe or dress yourself, Medicare will not pay, even if a nurse works in the building.
Your costs depend on how long you stay. You pay nothing for days 1 through 20. For days 21 through 100, you pay a daily coinsurance amount (in 2024, this is $194.50 per day, though this amount changes yearly). After day 100, Medicare pays nothing and you are responsible for the full cost.
Medicare Part A Coverage for Home Health Care
Medicare Part A also covers home health services — a nurse or therapist visiting your home — if your doctor orders them, you are homebound (leaving home is difficult and requires supportive information), and you need skilled care. Skilled care at home includes wound dressing, physical therapy, occupational therapy, speech therapy, and some nursing services.
Unlike the nursing home benefit, there is no time limit on home health coverage. You can receive services for as long as your doctor says they are medically necessary. You pay nothing for home health services covered by Medicare Part A — no copay, no coinsurance, no deductible.
Home health does not include custodial care — a home aide who helps you bathe or dress without a medical reason tied to a recent illness or injury. If you need only custodial help, Medicare will not pay, and you will need to pay privately or turn to Medicaid if you meet its income and asset limits.
What Medicare Does Not Cover
Medicare does not pay for custodial care, which is the bulk of what people need in long-term settings. Custodial care includes bathing, dressing, toileting, meal preparation, medication reminders, and supervision — the everyday help that allows someone to stay in their home or live in an assisted living facility. It also does not cover room and board in any setting, whether a nursing home or assisted living.
Medicare also does not cover long-term stays in assisted living facilities. Assisted living is designed for people who need help with daily activities but not skilled medical care. Because it is custodial, not skilled, Medicare will not pay for it at all.
Respite care — temporary care to give a family caregiver a break — is not covered by Medicare unless it happens to occur during a covered skilled nursing stay or home health episode. If you need someone to stay with you for a week so your adult child can take a vacation, you will pay out of pocket.
How Medicaid Pays for Long-Term Care
Medicaid, a joint federal and state program, is the primary payer for long-term custodial care in nursing homes and assisted living. Unlike Medicare, Medicaid has no time limit and covers the custodial care that Medicare does not. However, Medicaid has strict income and asset limits that vary by state.
To may have access to for Medicaid coverage of long-term care, your income and assets must fall below your state's threshold. Most states allow you to keep your home, one vehicle, and some personal items, but liquid assets are usually limited to $2,000 to $3,000 (the exact amount varies by state). If you have more, you must spend it down on care costs before Medicaid begins paying.
Medicaid also protects a portion of assets for your spouse if you are married. The rules are complex and vary significantly by state, so speaking with an elder law attorney or your state Medicaid office before you need care can help you understand what you will face.
Long-Term Care Insurance as an Alternative
Long-term care insurance is a private insurance policy that pays for custodial care in a nursing home, assisted living facility, or your own home. It covers costs that Medicare does not, including room and board and help with daily activities. Policies vary widely in what they cover, how much they pay per day, and how long they pay.
The cost of a long-term care insurance policy depends on your age and health when you buy it. Premiums are lower if you buy in your 50s or early 60s, before you have serious health conditions. If you wait until your 70s or have a history of heart disease, diabetes, or cognitive decline, premiums rise sharply or you may be denied coverage altogether.
Long-term care insurance is not right for everyone. If your assets are very small, you will likely may have access to for Medicaid anyway. If your assets are very large, you may be able to pay for care out of pocket. The middle ground — people with moderate assets who want to protect them — is where long-term care insurance is most useful.
Planning Ahead: Questions to Ask Yourself
Because Medicare covers so little long-term care, planning ahead matters. Ask yourself: Do I have assets I want to protect for my heirs? Can I afford to pay for several years of care out of pocket? Do I have family members who can provide unpaid care? Would I prefer to stay in my home or move to a facility?
Your answers shape your next steps. If you have significant assets and want to protect them, long-term care insurance purchased in your 50s or early 60s may make sense. If your assets are modest, understanding your state's Medicaid rules now — before you need care — helps you make informed decisions. If you want to stay home as long as possible, exploring home care options and home modifications now can extend your independence.
Talking with your family about your wishes and your finances is also important. Many people avoid these conversations, but knowing what your parents want and what resources they have makes the transition to long-term care far less stressful when the time comes.
Frequently Asked Questions
Does Medicare pay for assisted living?
No. Medicare does not pay for assisted living at all because assisted living is custodial care — help with daily activities — not skilled medical care. You pay for assisted living out of pocket or through Medicaid if you meet your state's income and asset limits.
What happens after Medicare stops paying for skilled nursing care?
After day 100, you are responsible for the full cost of the nursing home. If you cannot pay, you can turn to Medicaid if you meet income and asset limits, or you may need to move to a less expensive facility. Some people return home with family support or home health services at this point.
Can Medicare pay for in-home care if I am not homebound?
No. Medicare home health requires that you be homebound — leaving home is difficult and requires supportive information. If you can leave home independently, Medicare will not pay for home care, even if your doctor thinks it would help you.
Does long-term care insurance cover everything Medicare does not?
It depends on the policy. Long-term care insurance typically covers custodial care and room and board, but policies have daily limits, waiting periods, and maximum benefit periods. Read the policy details carefully to understand what is and is not covered.
Can I get Medicaid to pay for long-term care if I have a house?
Yes, in most states. Medicaid allows you to keep your primary residence and still may have access to, though your state may place a lien on the house to recover costs after you pass away. The rules vary by state, so check with your state Medicaid office or an elder law attorney.