Does Medicare Cover Long-Term Care?

Key Takeaways

• Medicare coverage of long-term care is limited. It primarily covers short-term skilled nursing care and rehabilitation services.
• It’s important to plan ahead for long-term care needs, as skilled nursing and assisted living facilities can be prohibitively expensive.
• Understanding alternative funding options like long-term care insurance can get you the help you need while protecting your finances.

Long-term care is a complex and often costly part of healthcare.

Many assume Medicare will cover all their long-term care needs, but that’s not exactly the case.

Let’s explore what Medicare does and doesn’t cover in terms of long-term care and how you can be better prepared to face such needs in the future.

What Medicare Covers for Long-Term Care

Medicare coverage of long-term care services is specific and limited.

• Medicare Part A covers up to 100 days of skilled nursing care in a Medicare-approved facility after a qualifying hospital stay. It also covers rehabilitative services such as physical therapy and occupational therapy for recovery after an illness or injury.
• Medicare Part B: If medically necessary, Part B covers some home health care services.

However, Original Medicare does not cover custodial care – the type of care most people think when considering long-term care. That includes non-medical support and help with daily activities like:

• Bathing and dressing.
• Meal preparation.
• Medication management.
• General supervision and safety.

Medicare also does not cover assisted living and nursing home care unless it is part of a short-term skilled nursing service.

Learn more: What Medicare Covers

Get Personalized Medicare Advice for Your Mental Health Needs

Understanding mental health coverage under Medicare can seem complicated, but it doesn’t have to be.

At CoverRight, we provide concierge Medicare services to help you compare plans, understand benefits, and make confident decisions.

Reach out to us today to improve your Medicare experience.

Exploring Alternative Long-Term Care Funding Options

Since Medicare coverage of long-term care is limited, it’s important to understand your alternatives.

Here are some funding options you can explore:

• Medicaid: Medicaid is a state-funded program that provides long-term care coverage for low-income individuals. Eligibility requirements vary by state.
• Long-term care insurance: This type of insurance can cover the cost of long-term care services. Compare policies carefully to understand coverage details and limitations.
• Personal savings and investments: You can use your retirement savings or earnings from investments to help pay for long-term care costs.
• Annuities: Annuities are a type of insurance that can provide income for life. Some annuities have long-term care riders that specifically help with long-term care expenses.
• Reverse mortgages: This type of loan allows homeowners to borrow against the equity in their homes. Consult with a financial advisor to full understand the risks involved.

Let’s compare the features of these funding options:

Learn more: Supplemental Insurance With Medicare

Planning for Long-Term Care Needs

It’s best to start planning for potential long-term care needs while you’re still healthy.

This gives you time to assess your financial situation, evaluate your health risks, and explore different funding options.

Here are the steps we recommend:

• Estimate your long-term care costs: Look for the average cost of long-term care in your area. Then, use online calculators or consult with a financial advisor to estimate how much long-term care could cost you.
• Assess your health risks: Consider your family history and lifestyle to determine your chances of needing long-term care.
• Explore funding options: Research different long-term care funding options, evaluate your retirement savings and income sources and consider whether your family can provide care if needed.
• Get professional advice: Consult a licensed insurance agent like CoverRight to help create a long-term care plan.

According to the latest Cost of Care Survey, the national annual median cost2 of a semi-private room in a skilled nursing facility was $104,000, and $64,200 for an assisted living facility. These costs are likely to increase as time passes.

Learn more: Assisted Living Facility – A Supportive Residential Option for Senior Care.

How to Supplement Medicare with Additional Coverage

You can consider long-term care insurance to bridge the gap left by Medicare.

Look for policies that:

• Offer inflation protection to keep pace with rising healthcare costs.
• Include a range of care settings (home care, assisted living, nursing homes).
• Have a strong financial rating and a history of rate stability.
• Provide clear elimination periods and benefit triggers.

According to the American Association for Long-Term Care Insurance, the best age3 to purchase long-term care insurance is your mid-50s. Premiums are more affordable at this age and you’re more likely to qualify.

Sounds like a lot?

CoverRight can provide personalized guidance to help you navigate these choices and find the best plan for you.

Learn more: Coverage Restrictions – Understanding Limitations in Healthcare Insurance.

Get Help Planning for Long-Term Care

You can make up for Medicare’s limited long-term care coverage by exploring alternate options and planning early.

Licensed advisors at CoverRight can help you:

• Understand your Medicare coverage and its limitations.
• Explore supplemental insurance options.
• Create a personalized long-term care strategy.
• Find solutions that fit your budget and needs.

Personalized Guidance for Your Medicare Needs

Navigating long-term care can be complicated. There’s a lot to consider between Medicare’s limited coverage and the wide range of alternative funding options.

If you’re feeling overwhelmed, let CoverRight simplify the process for you.

Get started today.

Sources

1. Medicaid Long-Term Care
   • Three Types of Medicaid Long-Term Care. Available at: medicaidlongtermcare.org. Last Accessed February 6, 2025.
2. Genworth
   • Genworth Releases Cost of Care Survey Results for 2023. Available at: investor.genworth.com. Last Accessed February 6, 2025.
3. American Association for Long-Term Care Insurance
   • Best Age to Buy Long-Term Care Insurance. Available at: aaltci.org. Last Accessed February 6, 2025.

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