Medicare covers some skilled nursing and rehabilitation, but not custodial long-term care

Medicare does not pay for long-term custodial care — the kind of ongoing help with daily living that most people mean when they say "long-term care." Medicare Part A covers a limited stay in a skilled nursing facility after a hospital stay, and Part B covers some rehabilitation services at home. But if you need help with bathing, dressing, meals, or medication reminders for months or years, Medicare will not pay for that. You would need to pay out of pocket, use Medicaid, or have a long-term care insurance policy.

Understanding this gap matters because many people assume Medicare covers what it does not. The result is often a sudden, expensive discovery when a spouse or parent needs ongoing care. Knowing the real boundaries now helps you plan ahead.

Key Takeaways

  • Medicare Part A covers up to 100 days in a skilled nursing facility only after a hospital stay of at least three days, and only for skilled care — not custodial help.
  • Medicare Part B covers some home health services, but only if a doctor orders them, you are homebound, and the care is skilled (wound care, physical therapy, nursing), not personal information.
  • Custodial care — help with bathing, dressing, meals, and toileting — is never covered by Medicare, no matter how long you need it.
  • Medicaid, not Medicare, is the main government program that pays for long-term custodial care, but it requires a low income and assets test.
  • Long-term care insurance, purchased before you need care, is the main way people outside Medicaid pay for years of ongoing information.

What Medicare Part A covers in a skilled nursing facility

After you spend at least three consecutive days in a hospital, Medicare Part A will pay for a stay in a skilled nursing facility (SNF) — a nursing home or rehabilitation center that provides skilled medical care. The coverage works like this: Medicare pays the full cost for days 1 through 20. From day 21 through day 100, you pay a daily copay (the amount changes each year, but is currently around $200 per day). After day 100 in the same benefit period, you pay all costs yourself.

The key word is "skilled." Medicare pays only for care that requires a nurse or therapist — wound dressing, medication management, physical therapy, speech therapy, or monitoring after surgery. It does not pay for help with bathing, dressing, or meals unless that help is part of a skilled service. And the facility must be certified by Medicare; not all nursing homes are.

This coverage resets each benefit period. A benefit period begins the day you enter the hospital and ends 60 days after you leave the hospital or nursing facility without being readmitted. If you are readmitted after that 60-day gap, a new benefit period starts, and your day count resets to 1.

What Medicare Part B covers for home health care

If you are recovering at home after a hospital or nursing facility stay, Medicare Part B may pay for home health services — but only under strict conditions. A doctor must order the care, you must be homebound (unable to leave home without considerable effort), and the services must be skilled: nursing visits, physical therapy, occupational therapy, speech therapy, or medical social work. Medicare does not cover a home health aide unless a nurse or therapist is also visiting to provide skilled care.

Home health is meant to be temporary — typically a few weeks to a few months of recovery. If you need ongoing personal care (bathing, dressing, meal prep) without skilled services, Medicare will not pay. Some people hire a home health aide privately and pay out of pocket, but that is not a Medicare benefit.

To receive home health, you will need a doctor's order and a home health agency certified by Medicare. Your doctor can refer you, or you can ask your hospital discharge planner for a referral. Medicare covers the full cost of skilled home health services; you pay nothing if the agency is in-network.

Why custodial care is not covered by Medicare

Custodial care is help with the activities of daily living: bathing, dressing, grooming, toileting, eating, and moving around the house. It is the most common type of long-term care, and it is the most expensive for families to pay for privately. But Medicare does not cover it because custodial care does not require a nurse or doctor — it is personal information, not medical care.

This distinction matters legally and financially. A nursing home aide can help you bathe and dress, but if that is all you need, Medicare will not pay the nursing home bill. You would need to pay privately (often $4,000 to $8,000 per month, depending on your location and the facility) or turn to Medicaid if you meet income and asset limits.

Many people spend down their savings to may have access to for Medicaid, which then pays for custodial care in a nursing home or at home. Others purchase long-term care insurance years before they need it, which covers custodial care when the time comes. Understanding this gap now — before a crisis — gives you time to explore those options.

Medicaid as the alternative for long-term custodial care

Medicaid, not Medicare, is the government program that pays for long-term custodial care. Unlike Medicare (which is based on age and work history), Medicaid is a needs-based program run by each state. To receive Medicaid coverage for nursing home or home care, you must have a low income and limited assets. The income and asset limits vary by state, but most states allow only a few thousand dollars in savings.

Many people do not plan for this and end up spending their life savings on care until they may have access to for Medicaid. Some states have programs that let you protect a portion of assets for a spouse who stays at home, but the rules are complex and vary. If long-term care is a possibility in your family, speaking with an elder law attorney about Medicaid planning is worth the cost.

Medicaid also covers some home and community-based services in many states — allowing people to receive custodial care at home rather than in a nursing home. But again, you must meet the income and asset test, and the services available depend on your state.

Long-term care insurance as a private option

Long-term care insurance is a private insurance policy that pays for custodial care — in a nursing home, assisted living facility, or at home — when you need it. Unlike Medicare, it covers the personal information that Medicare does not. You buy the policy while you are healthy and working, pay premiums for years, and then if you need care later, the policy pays a daily or monthly benefit toward your care costs.

The cost and terms vary widely. A policy bought at age 55 might cost $1,500 to $3,000 per year; one bought at 65 might cost $3,000 to $6,000 per year. The policy specifies how much it will pay per day (often $100 to $300), how long it will pay (often three to five years or lifetime), and what triggers coverage (usually needing help with two or more activities of daily living). Many policies also cover cognitive decline like dementia.

Long-term care insurance is not right for everyone — it is expensive, and you may never need it. But for people with substantial assets and no family to provide care, it can protect savings from being wiped out by years of nursing home costs.

Medicare Advantage plans and long-term care coverage

Some Medicare Advantage plans (Part C plans) offer supplemental benefits that traditional Medicare does not, including limited long-term care or home and community-based services. These vary by plan and by year. A few plans cover a small number of days in a nursing home or assisted living, or offer a modest benefit toward in-home care. But these are extras, not core coverage, and they are not available in all plans or all areas.

If you are considering a Medicare Advantage plan, ask the plan directly whether it covers any long-term care services and what the limits are. Do not assume it does. And remember that even if it does, the coverage is usually limited — a few weeks or months, not years. It is a supplement to other planning, not a replacement for long-term care insurance or Medicaid planning.

Frequently Asked Questions

Does Medicare cover assisted living?

No. Medicare does not pay for assisted living facilities or the personal care they provide. If you need help with daily living but not skilled nursing care, you would pay for assisted living privately, use Medicaid if you may have access to, or rely on family. Some Medicare Advantage plans offer small supplemental benefits toward assisted living, but these are rare and limited.

What if I need long-term care but do not have insurance or savings?

Medicaid is the safety net. If your income and assets fall below your state's limits, Medicaid will pay for nursing home care or home-based services. Many people spend down their savings to reach Medicaid may be able to access, though some states allow you to protect a portion for a spouse. An elder law attorney can explain your state's rules and options.

Can I use my Medicare supplement insurance to pay for long-term care?

No. Medigap (Medicare supplement) policies cover costs that Medicare does not — like copays and deductibles — but they do not cover custodial long-term care. Long-term care insurance is a separate policy designed specifically for that purpose.

How long does Medicare Part A cover in a nursing home?

Up to 100 days per benefit period, but only after a hospital stay of at least three days. Medicare pays fully for days 1 through 20, and you pay a copay for days 21 through 100. After 100 days, you pay all costs. A new benefit period begins 60 days after you leave the hospital or nursing facility.

What happens if I need care after my 100 Medicare days run out?

You pay privately, or you turn to Medicaid if you may have access to. Some people have long-term care insurance that kicks in at this point. Others rely on family or move to a less expensive care setting. Planning ahead — before you need care — gives you more options.