Does Medicare Cover Long-Term Care?

Medicare does not typically cover long-term care or any care classified as custodial care, which is care that helps with basic personal tasks such as dressing, eating and using the bathroom.

Although Medicare does not cover long-term custodial care (including nursing home care), Medicare may help cover other specialized types of care for limited periods of time:

  • Care in a long-term care hospital*
  • Skilled nursing care in a skilled nursing facility
  • Eligible home health services
  • Hospice and respite care

Learn more about these aspects of Medicare coverage.

*Long-term care hospitals do not provide long-term custodial care, despite the name. Long-term care hospitals focus on patients who require longer hospitalizations related to serious illnesses or conditions.

Smiling home health care nurse and her patient

Medicare Part A covers services received in long-term care hospitals (LTCH)

Medicare Part A provides hospital insurance and covers care received in a long-term care hospital (LTCH). You may qualify for this type of care if you meet the following two requirements:

  • You have more than one serious health condition
  • You may improve with care and time, eventually being able to return home

You generally must meet your Part A deductible for each benefit period during which you are admitted for an inpatient stay at an LTCH. The 2019 Medicare Part A deductible is $1,364 per benefit period.

After you meet the Part A deductible, you are responsible for Part A coinsurance payments of $341 per day (in 2019) for days 61-90 of your inpatient stay in each benefit period, and $682 per day for days 91 and beyond in each benefit period until you exhaust your 60 lifetime reserve days. When your 60 lifetime reserve days are used up, you are responsible for all costs.

Medicare Part A covers care in a skilled nursing facility (SNF)

Medicare Part A covers services you receive in a skilled nursing facility (SNF) that can include meals, physical therapy, medical supplies, a shared semi-private room and more for a limited period of time.

You may be eligible for care in an SNF if you meet all of the following conditions:

  • There are days left in your Part A benefit period
  • You experience a qualifying hospital stay
  • A doctor decides you need daily skilled care from skilled nursing or therapy staff
  • Your SNF is certified by Medicare
  • You need this care for a hospital-related health condition or a condition that started while you were in an SNF for a hospital-related condition

You will also need to meet your Part A deductible for each benefit period before Medicare Part A begins paying for your SNF care. Your Part A coinsurance in 2019 is $170.50 per day for days 21-100 of your stay, and you pay all costs for days 101 and beyond.

Medicare Part A and/or Part B cover some home health services

Medicare Part A and Part B medical insurance cover some home health services, such as:

  • Part-time or intermittent skilled nursing care
  • Part-time or intermittent home health care services
  • Physical or occupational therapy
  • Speech-language pathology services
  • Medical social services

Medicare Part A and Part B will not cover the following home health services:

  • Meal delivery
  • Custodial care or 24-hour-a-day care
  • Homemaker services

You  may qualify for these Medicare-covered services if you meet the following requirements:

  • You are under the care of a doctor and receive care under a doctor’s care plan
  • A doctor certifies that you need physical or occupational therapy or speech-language pathology services
  • A doctor certifies that you are homebound

You typically have no Medicare costs for home health care services, and you typically pay 20 percent of the Medicare-approved amount for qualified durable medical equipment (DME) you may require while receiving home health care.

Check with your home health care agency to confirm how much Medicare will pay for your care.

Medicare Part A covers hospice care

Medicare Part A will cover hospice care you receive at home or in a hospice inpatient facility. Depending on your terminal condition or illness, Medicare will cover:

  • Doctor and nursing care services
  • Medical equipment
  • Medical supplies
  • Prescription drugs to help with symptom control or pain relief
  • Physical or occupational therapy
  • Social work services
  • Speech-language pathology therapy
  • Dietary counseling
  • Short term respite care and inpatient care
  • Grief counseling

Medicare Part A will cover your hospice care if you meet the following criteria:

  • Your hospice doctor and your regular doctor certify that you’re terminally ill
  • You accept palliative care for comfort rather than care intended to cure your illness
  • You sign a statement stating that you choose hospice care

You typically do not pay for Medicare-covered hospice care. You may need to pay up to $5 for each prescription drug you take for pain relief and symptom control. You may also need to pay 5 percent of the Medicare-approved amount for inpatient respite care.

Medicare Advantage plans

Medicare Advantage plans (Medicare Part C) replace your Part A and Part B benefits with a private insurance plan. Every Part C plan must provide the same hospital and medical benefits as Original Medicare (Part A and Part B).

This means that Medicare Advantage plans cover the same specialized care that is outlined above. The only exception is hospice care, which you will still receive through your Medicare Part A benefits.

Many Medicare Advantage plans also cover prescription drugs, and some plans may also provide coverage for:

Starting in 2019, some Medicare Advantage plans may also cover home-delivered meals, grab bars for home bathrooms and other additional benefits.

Find a Medicare Advantage plan to help cover your care

A licensed insurance agent can help you compare Medicare Advantage plans in your area that cover the qualified long-term care you need. An agent can even help you enroll in a plan right over the phone.

To get started, call TTY Users: 711 today, 24 hours a day, 7 days a week.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

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