Does Medicare Pay for Long-Term Care?

The Critical Distinction: Skilled Care vs. Custodial Care

Understanding this distinction is essential to understanding Medicare's role in long-term care.

Skilled care is medical care provided by or under the supervision of licensed professionals — registered nurses, physical therapists, occupational therapists or speech therapists. Examples: wound care, IV therapy, post-surgical monitoring, physical rehabilitation after a hip replacement.

Custodial care is help with activities of daily living — bathing, dressing, eating, toileting, mobility. This is the type of care most people need in assisted living and nursing homes over the long term. Custodial care does not require a licensed medical professional to provide.

Medicare covers skilled care. Medicare does not cover custodial care. This is the rule that surprises most families.

Medicare and Skilled Nursing Facility Care

Medicare Part A may cover a stay in a skilled nursing facility (SNF) under these conditions:

• The person had a qualifying inpatient hospital stay of at least 3 consecutive days (not counting the discharge day)
• The person is admitted to a Medicare-certified SNF within 30 days of the hospital discharge
• The person requires skilled nursing or skilled rehabilitation services on a daily basis
• The care is medically necessary and ordered by a physician

When all conditions are met, Medicare covers:

• Days 1–20: Medicare pays 100% of the approved amount
• Days 21–100: Medicare pays after a daily co-pay ($200 per day in 2024 — this amount changes annually)
• After day 100: Medicare pays nothing

Medicare and Home Health Care

Medicare Part A and Part B may cover skilled home health care when:

• The person is homebound (leaving home requires considerable effort)
• A physician certifies that skilled care is medically necessary
• The care is provided by a Medicare-certified home health agency
• The person needs skilled nursing, physical therapy, occupational therapy or speech therapy

Covered services may include skilled nursing visits, therapy services and home health aide services (only when skilled care is also being provided). Medicare does not cover home health aide services alone for personal care without a skilled care need.

Medicare does not cover 24-hour home care, meals delivered to the home, homemaker services or personal care when that is the only care needed.

What Medicare Does Not Cover

• Assisted living room and board or personal care services
• Memory care room and board
• Long-term nursing home residence for custodial purposes
• Ongoing personal care at home (bathing, dressing, eating) without a skilled care need
• Adult day services
• Homemaker services
• 24-hour home care

Medicare Advantage (Part C)

Medicare Advantage plans are offered by private insurers and must cover everything Original Medicare covers. Some plans offer supplemental benefits — such as limited personal care, adult day services or meal delivery — that Original Medicare does not cover. However, these supplemental benefits are limited and do not cover the full cost of long-term care.

Review your specific plan's Evidence of Coverage document to understand exactly what supplemental benefits are included.

Official Medicare Resources

• Medicare.gov: official Medicare information — medicare.gov
• Medicare Care Compare: nursing home ratings and inspection reports — medicare.gov/care-compare
• Medicare & You handbook: published annually by CMS — available at medicare.gov
• State Health Insurance Assistance Programs (SHIP): free Medicare counseling — find yours at shiphelp.org