Is Long-Term Care Covered by Medicare? 

In the United States, statistics show that around 70 percent of seniors will need some sort of long-term care during their lives. There are over 65,000 long-term care facilities in this country ready to provide that care. 

A person who relies on long-term care typically needs help with personal (custodial) care like bathing, dressing, and eating, as well as medical care like taking medications and having wounds treated.

While long-term care in nursing facilities is often associated with old age, many people need this type of care after a serious illness, heart attack, or stroke. If you or a loved one needs help with daily self-care activities, you should be aware of what your Medicare coverage includes.  

Does Medicare cover long-term care? 

Medicare covers some types of long-term care if you need it for medical reasons and notfor personal (custodial) care. If you are admitted to a skilled nursing home, and you receive medical and custodial care, you pay 100 percent of your non-covered services. 

What long-term care services are covered in skilled nursing facilities?

Original Medicare Part A (hospital insurance) covers short stays in skilled nursing care facilities when they are medically necessary after a three-day (at least) stay as an inpatient in a hospital. 

You might need to stay in a nursing facility for professional care after an injury or surgery, during recovery from a heart attack or stroke, or for intravenous medication treatments necessary to treat a severe illness. During your stay in a skilled nursing facility, you have access to Medicare Part A covered services provided by registered nurses, physical therapists, occupational therapists, speech-language therapists, and audiologists. 

Original Medicare Part A covers the entire cost of your stay in a skilled nursing facility for the first twenty days. From day 21 to day 100, you are responsible for making a daily coinsurance payment. After day 100, you’re responsible for 100 percent of all costs.

Does Medicare cover long term care at home?

You may be eligible for long-term medical (not custodial) services in your own home if your physician certifies that the services are medically necessary. 

Original Medicare Parts A and B cover the following home care services:

• Part time skilled nursing care
• Physical, occupational, and speech-language therapy
• Injectable osteoporosis drugs
• Durable medical equipment

Original Medicare Part A pays 100 percent of the cost for covered home care services. Medicare Part B pays 80 percent of the cost for necessary durable medical equipment (DME) that you need to use at home. You must rent or purchase prescribed DME from a medical supplier that accepts Medicare assignment to be eligible for this benefit. 

How does Medicare cover long term care in hospice?

Original Medicare Part A typically covers 100 percent of the costs associated with hospice care when you are admitted to a Medicare-affiliated facility, but you may need to pay copayments for respite care or prescription medications. 

Even if you have a Medicare Advantage (MA) plan, your care reverts to Original Medicare Part A when you are admitted to hospice care. Medical care you receive outside of hospice care is still covered by your MA plan. 

In general, if you’re enrolled in a Medicare Advantage plan, your provider must cover, at minimum, the same long-term care services as Original Medicare Parts A and B. Most Part C plans include additional coverage and extra benefits, so you may have more coverage than Original Medicare offers. 

However, depending on the type of MA plan you have, you may need to use medical providers and facilities that are included in your plan’s network. You may also have different coinsurance charges.