What long-term care costs does Medicare cover?

July 10, 2024
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Stethoscope with medicare form with parts list.
Medicare may not be as comprehensive as you’d expect when it comes to long-term care coverage.

CAROL YEPES/Getty Images


Over the past few decades, the expenses associated with extended medical care, assisted living and nursing home facilities have surged. According to data from Genworth, the average cost of a private room in a nursing home now exceeds $100,000 per year. And, assisted living facilities, while somewhat less expensive, still command an average yearly fee of over $50,000. Even in-home care services, often seen as a more affordable option, can quickly drain savings. 

Given the magnitude of these potential expenses, it’s important to plan for long-term care well before retirement. But many people expect their Medicare coverage, which they rely on to manage their healthcare costs after they stop working, to cover them. After all, these programs provide essential coverage for a wide range of medical needs, from routine check-ups to hospital stays and prescription drugs, significantly reducing the out-of-pocket expenses for many medical services.

While Medicare can be an invaluable resource for retirees, however, the program was designed to cover acute medical needs and short-term care, not the kind of extended support often required in long-term care situations. This raises an important question: What long-term care costs does Medicare actually cover? 

Find out more about how long-term care insurance could benefit you.

What long-term care costs does Medicare cover?

Medicare’s coverage of long-term care costs is quite limited. Here’s what Medicare does and doesn’t cover in terms of long-term care:

Skilled nursing facility care

Medicare Part A will cover skilled nursing facility care, but only under specific conditions and for a limited time. To qualify, you must have had a qualifying hospital stay of at least three days and require skilled care related to that hospitalization. Coverage is limited to 100 days per benefit period, with full coverage for the first 20 days and partial coverage for days 21-100.

Explore your top long-term care insurance options online now.

Home health care

Medicare will cover part-time skilled nursing care, physical therapy, occupational therapy and other skilled care services provided in your home if you meet certain conditions. However, this coverage is typically short-term and does not include 24-hour care, meal delivery, or help with activities of daily living like bathing and dressing.

Hospice care

For those with terminal illnesses, Medicare provides comprehensive hospice coverage, including medical care, prescription drugs for symptom control and support services for patients and their families.

Hospital stays

While not typically considered long-term care, Medicare does cover inpatient hospital stays, which can sometimes be extended in cases of severe illness or injury.

It’s important to note that Medicare does not cover:

  • Custodial care (help with activities of daily living) when that’s the only care needed
  • Long-term care in assisted living facilities or nursing homes beyond the limited skilled nursing facility coverage mentioned above
  • Non-medical home care services

How to cover the costs of long-term care

Given these limitations, relying solely on Medicare for long-term care needs is not a viable strategy for most retirees. Here are other strategies you may want to consider instead:

Long-term care insurance

The right long-term care insurance policy is often the most comprehensive solution for addressing long-term care costs. That’s because long-term care insurance is specifically designed to cover the expenses for extended care needs, including assisted living, nursing home care and in-home care services. 

These policies will typically offer:

Savings and investments

Building a dedicated fund for long-term care expenses through consistent saving and strategic investing can help offset future costs. This approach requires discipline and early planning but offers flexibility in how funds are used.

Health savings accounts

If you’re eligible, contributing to a health savings account (HSA) while you’re still working can provide a tax-advantaged way to save for future healthcare expenses, including some long-term care costs.

Medicaid

Medicaid can provide more extensive long-term care coverage for those who meet income and asset requirements. However, this option typically is geared toward low-income seniors and requires that you spend down assets to qualify — so it generally won’t be an option for those with substantial retirement savings or assets.

The bottom line

As the cost of long-term care continues to rise and life expectancies continue to increase, taking proactive steps to address long-term care needs is an essential part of comprehensive retirement planning. And, while Medicare plays a crucial role in providing healthcare coverage for seniors, its limited long-term care benefits highlight the need for additional planning. Luckily, by understanding these limitations and exploring alternative options like long-term care insurance, you can be better prepared for the potential costs associated with aging. 

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