Medicare does not cover long-term custodial care, but it typically covers skilled nursing facility care, hospice care, and some medically necessary in-home care services.

Many adults need some type of long-term care during their lifetime. But it’s not always clear whether it’s covered or not. If you or a loved one have Medicare, you might be wondering about your options regarding long-term care.

Keep reading to learn what type of long-term care is covered under Medicare, who is eligible to receive coverage, and how to get help paying for it.

Medicare covers certain types of medically necessary long-term care.

Here are the long-term care services that Medicare covers:

Skilled nursing facilities

A skilled nursing facility (SNF) can provide medical or health-related services from a professional or technical staff to monitor, manage, or treat a health condition after a qualifying inpatient stay in a hospital. Staff at an SNF include professionals such as:

Examples of when someone might need SNF care include:

  • recovering from an acute health condition, such as a heart attack or stroke
  • physical or occupational therapy after an injury or surgery
  • care that requires intravenous (IV) medications, such as after a severe infection or long illness

Medicare Part A covers short stays at an SNF. Covered costs depend on the length of stay:

  • Days 1 through 20: Part A pays the entire cost of any covered services.
  • Days 21 through 100: Part A pays for all covered services, but you’re now responsible for a daily coinsurance payment. For 2024, this is $204 per day.
  • After 100 days: Part A pays nothing. You’re responsible for the entire cost of SNF services.

Medicare Part C (Medicare Advantage) and Medicare Supplement (Medigap) plans may cover some of the costs not covered by Part A. If you’re deciding what type of Medicare plans to enroll in, it’s important to consider these plans as well.

In-home care

In-home care involves any healthcare services that you receive in your home, instead of going to a hospital or doctor’s office. Typically, these in-home care services are coordinated with a home healthcare agency. Both Medicare Parts A and B can cover this type of care.

Services provided during in-home care can include:

  • part-time skilled nursing care or hands-on care
  • physical therapy
  • occupational therapy
  • speech-language therapy
  • wound care

Medicare covers medically necessary services only. Custodial care, meal preparation, and cleaning aren’t covered.

If you have Original Medicare, you won’t pay anything for covered in-home healthcare services. You will, however, need to pay 20% of the cost for necessary durable medical equipment (DME) after you meet the Medicare Part B deductible.

Examples of DME include:

  • wheelchairs
  • walkers
  • hospital beds

Hospice care

Hospice care is a special type of care that someone receives when treatment to cure a serious illness has stopped and a doctor certifies that the person seeking hospice care has a life expectancy of 6 months or fewer. Hospice care focuses on managing symptoms and providing support.

Examples of services provided during hospice care include:

  • care from doctors and nurses, including exams and visits
  • medications or short-term inpatient care to manage symptoms and ease pain
  • medical devices or supplies, such as wheelchairs, walkers, or bandages
  • physical and occupational therapy
  • short-term respite care, which involves care at a nursing home or hospital during times when a caregiver is not available
  • grief counseling for your family and loved ones

Medicare Part A generally covers all costs of hospice care, with the possible exception of small copays for respite care or prescriptions. Medicare also doesn’t pay for room and board while you’re receiving hospice care.

Medicare no longer covers some expenses after hospice benefits start. These include any medication or treatment intended to cure an end stage illness. It’s important to coordinate a plan with a hospice care team to ensure everything is organized and covered.

If a person decides to pursue curative treatment, they can stop hospice care.

To receive benefits, you must first be eligible for Original Medicare (Part A and Part B) by meeting one of the following requirements:

  • Be 65 years or older: You can enroll beginning 3 months before your 65th birthday.
  • Have a disability: You can enroll beginning 3 months before you reach the 25th month of receiving disability benefits.
  • Have end stage renal disease: Enrollment times can depend on your individual situation.

Once you have enrolled in Original Medicare, you’re eligible to receive coverage for long-term care.

Am I eligible for a skilled nursing facility?

To qualify for coverage to stay at an SNF, you must first have a qualifying hospital stay. This stay must last at least 3 consecutive days and be classified as “inpatient.”

Your doctor must also document that you need daily inpatient care or supervision that can be given at an SNF only. You’ll typically need to enter the SNF within 30 days of leaving the hospital.

Am I eligible for in-home care?

If you have Original Medicare, you qualify for in-home care if your doctor classifies you as “homebound.” This means that you have trouble leaving home without assistive equipment (such as a wheelchair) or the help of another person.

Your doctor must also certify that you need skilled medical services that can be provided at home. Examples include part-time skilled nursing care, physical therapy, or occupational therapy. Your doctor will create a plan of care for you.

Am I eligible for hospice care?

To be eligible for hospice care coverage, you must:

  • Have an estimated life span of less than 6 months, although your doctor can extend this if necessary.
  • Choose to accept palliative care instead of treatment to cure your condition. Palliative care is focused on providing comfort and support.
  • Sign a statement indicating that you’ve chosen hospice care for your condition instead of other Medicare-covered treatments.

Although Medicare covers some services of long-term care, there are many others that it doesn’t cover.

Medicare does not cover custodial care, which involves assistance with daily living activities like eating, dressing, and using the toilet. It’s a big component of the care that’s provided in nursing homes or assisted living facilities.

For additional help with long-term care that isn’t covered by Medicare, consider the following options:

  • Medicare Advantage: Private insurance companies offer these plans. Some Advantage plans may offer more long-term care benefits than Original Medicare.
  • Medigap: Like Advantage plans, private insurance companies sell these policies. Medigap plans can help with coinsurance and copayments costs associated with long-term care.
  • Medicaid: Medicaid is a joint federal and state program that supplies healthcare for free or at a low cost. The available programs and income eligibility requirements can vary by state. Find out more through the Medicaid site.
  • Long-term care insurance: Some insurance companies sell a type of policy called long-term care insurance. These policies are meant to cover long-term care, including custodial care.
  • Program of All-inclusive Care for the Elderly (PACE): PACE is a program that’s available in some states to help cover costs associated with medical or long-term care provided at home. Visit the PACE site to learn more.
  • Department of Veterans Affairs (VA): The VA may help provide long-term care for some veterans. To learn more about potential benefits, contact your local VA health center or visit the VA site.
  • Out of pocket: If you choose to pay out of pocket, that means you’ll be paying for all the costs of long-term care on your own.

Medicare covers some types of long-term care including in-home care, hospice care, and short stays at SNFs. To be eligible for coverage, you must meet certain requirements.

Some aspects of long-term care aren’t covered by Medicare. These include nonmedical services commonly provided at nursing homes and assisted living facilities, such as custodial care and room and board.

You may have additional ways to get assistance for the costs of long-term care. Some of these include enrolling in an Advantage or Medigap plan, enrolling in Medicaid, or buying a long-term care insurance policy.