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Since 2011, we've helped more than 5 million people understand their Medicare coverage.
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We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1–800– MEDICARE to get information on all of your options.
Since Medicare does not cover most long-term care needs, many older Americans who need long-term care services (ie, custodial care, as opposed to medical care) find themselves turning to Medicaid, which does cover long-term care for eligible enrollees.
In addition to satisfying income and asset limits, applicants seeking Medicaid long-term care coverage must demonstrate certain care needs to be eligible for this coverage.
Medicaid will only cover nursing home benefits for applicants who need to be cared for in a nursing home – and can’t receive long-term care elsewhere.
The “level of care” is the setting in which an individual needs medical or long-term care services. In most states, applicants who require a nursing home “level of care” have medical conditions or functional limitations that result in being a danger to oneself.
Applicants for Medicaid long-term care coverage have to undergo an assessment by medical doctors, social workers, or other evaluators designated by their state’s Medicaid agency. This evaluation may consider the medical, cognitive, mental health, and functional issues an applicant has.
Evaluators will use an assessment tool to determine whether the applicant needs long-term care, and at which “level of care” and setting those services should be provided (e.g., in a nursing home or assisted living facility, or community- or home-based care).
Applicants usually are assessed for how much assistance they need with activities of daily living (ADLs) – such as eating, bathing, and dressing.
Although these assessments vary in each state, they may consider whether an individual:
The good news is that while Medicare’s role in long-term care is complicated, you can head off much of the headache that comes with the financial burden of long-term care by understanding some basic concepts.
Our guide to financial assistance for Medicare enrollees includes information about HCBS, Medicaid spend-down, Medicaid for the aged, blind and disabled – and more.
Medicare will generally pay for services related to your loved one's specific illnesses or injuries, but it generally won't help cover the cost of supportive care for everyday living.
The good news is that while Medicare’s role in long-term care is complicated, you can head off much of the headache that comes with the financial burden of long-term care by understanding some basic concepts.
Our guide to financial assistance for Medicare enrollees includes information about HCBS, Medicaid spend-down, Medicaid for the aged, blind and disabled – and more.
Medicare will generally pay for services related to your loved one's specific illnesses or injuries, but it generally won't help cover the cost of supportive care for everyday living.
