Does Medicare Cover Long-Term Care Facilities?

When a loved one needs extended custodial care, families often turn to Medicare for help. However, the reality of Medicare coverage for long-term care facilities is more limited than many expect. Understanding what is covered, what is not, and how to fill the gaps can save you thousands of dollars and prevent stressful surprises. This guide explains the precise rules, costs, and alternatives you need to know.

What Medicare Actually Pays For in Long-Term Care

Original Medicare (Part A and Part B) does not pay for long-term custodial care in a nursing home or assisted living facility if you only need help with daily activities like bathing, dressing, or eating. This type of care is considered non-medical, and Medicare explicitly excludes it. Instead, Medicare covers skilled nursing facility (SNF) care under strict conditions.

Skilled nursing care includes services like intravenous injections, physical therapy, wound care, and other treatments that require a licensed professional. To qualify, you must have a qualifying hospital stay of at least three consecutive days (not counting the day of discharge), and your doctor must certify that you need daily skilled care for a condition that was treated during that hospital stay. You must enter a Medicare-certified skilled nursing facility within 30 days of leaving the hospital.

The 100-Day Limit and Daily Coinsurance

Even when you qualify, Medicare Part A covers a maximum of 100 days per benefit period. The first 20 days are covered in full after you meet the Part A deductible ($1,632 in 2026). For days 21 through 100, you pay a daily coinsurance amount ($408 in 2026). After day 100, you pay all costs unless you have other coverage. Importantly, if you go 60 consecutive days without receiving skilled care, a new benefit period starts, and you could qualify for another 100 days.

Many people assume Medicare will cover a long nursing home stay, but the reality is that most residents need custodial care, not skilled care. According to the U.S. Department of Health and Human Services, about 70% of people turning 65 will need some type of long-term care, but Medicare covers only a small fraction of those costs.

What About Medicare Advantage and Medigap?

Medicare Advantage plans (Part C) must cover at least the same skilled nursing facility benefits as Original Medicare. Some plans offer additional days or lower daily copays, but they do not cover custodial care. In our guide on when Medicare coverage starts, we explain how to avoid gaps that could delay your benefits. If you are considering a Medicare Advantage plan, check the plan’s network of skilled nursing facilities, since out-of-network care may cost more or be excluded.

Medigap (Medicare Supplement Insurance) policies sold after 2010 do not cover long-term custodial care. However, some older Medigap plans (like Plan F) may pay the Part A coinsurance for days 21-100. If you have a Medigap policy, review your benefits carefully, since nursing home coverage is not a standard feature.

Assisted Living Facilities and Memory Care

Assisted living facilities provide housing, meals, and personal care services but generally do not offer round-the-clock skilled nursing. Medicare does not cover room and board in assisted living. It may cover short-term skilled services provided in an assisted living facility, such as physical therapy or wound care, but only if a Medicare-certified home health agency delivers those services. Memory care units for Alzheimer’s or dementia patients also fall outside Medicare’s coverage, since the care is primarily custodial.

If you or a loved one is considering assisted living, you will need to pay out of pocket or rely on long-term care insurance. Some states offer Medicaid waivers that help pay for assisted living for low-income seniors, but eligibility rules vary widely.

How to Pay for Long-Term Care Without Medicare

Given Medicare’s limits, you need a plan to cover custodial care. Here are the most common options:

• Long-term care insurance: Purchased before you need care, this policy pays a daily benefit for nursing home, assisted living, or home care. Premiums are lower if you buy in your 50s or early 60s.
• Medicaid: For those with limited income and assets, Medicaid covers long-term custodial care in nursing homes. Eligibility rules are complex and often require spending down assets. Not all facilities accept Medicaid.
• Veterans benefits: The VA offers Aid and Attendance benefits for qualifying veterans and surviving spouses who need help with daily activities.
• Reverse mortgages or life insurance conversions: Some people use home equity or sell life insurance policies to fund care.

Each option has trade-offs. For example, long-term care insurance can be expensive, and you may never use it. Medicaid requires you to meet strict financial criteria, and you may have limited facility choices.

Frequently Asked Questions

Does Medicare pay for nursing home care for dementia patients?

Medicare does not pay for long-term custodial care in a nursing home for dementia patients. It only covers short-term skilled nursing care after a qualifying hospital stay. Dementia care that does not require daily skilled nursing is considered custodial.

Can Medicare cover home health aides instead of a facility?

Medicare covers home health care only if you are homebound and need part-time skilled nursing or therapy. It does not pay for full-time custodial care from a home health aide. You can get coverage for a few hours per week, but not 24-hour care.

What is the difference between skilled nursing and custodial care?

Skilled nursing requires a licensed professional (nurse or therapist) and is medically necessary. Custodial care helps with activities of daily living like bathing, dressing, and eating. Medicare covers only skilled care under strict conditions.

How do I find a Medicare-certified skilled nursing facility?

Use Medicare’s Nursing Home Compare tool at Medicare.gov. You can search for facilities that accept Medicare and compare quality ratings. Make sure the facility has a contract with Medicare and is accepting new patients.

For personalized help understanding your options, visit Blue Medicare Card: Easy Access to Your Medicare Coverage for a step-by-step overview of your benefits. You can also call 833-203-6742 to speak with a licensed agent who can review your situation.

Plan Ahead to Avoid Surprise Bills

Medicare coverage for long-term care facilities is narrow and time-limited. The best strategy is to plan before you need care. If you are approaching 65, consider buying long-term care insurance or reviewing your savings. If you already need care, talk to a hospital discharge planner or a Medicare counselor to understand your options. For more information on related coverage, see Medicare Coverage for Colonoscopy After a Positive Cologuard Test to see how Medicare handles preventive services.

Remember that Medicare’s role is to cover acute medical needs, not ongoing daily support. By understanding this distinction now, you can make informed decisions and protect your finances. For a deeper look at how Medicare benefits work in practice, read Medicare Coverage for Colonoscopy After Positive Cologuard for a real-world example of coverage rules. If you have questions about your specific situation, call 833-203-6742 for free guidance.