long-term care

What is long-term care?

Long-term care generally refers to non-medical care (i.e., custodial care) for patients who need assistance with basic daily activities such as dressing, bathing and using the bathroom. Long-term care may be provided at home or in facilities that include nursing homes and assisted living.

Does Medicare cover long-term care?

No, Medicare generally does not pay for custodial long-term care, whether it’s in a nursing home or provided in-home.¹

However, Medicare will cover some in-home custodial care (such as assistance with bathing or feeding, for example) if it’s provided simultaneously with in-home skilled nursing care or physical/speech/occupational therapy.²

And Medicare will also cover up to 100 days in a skilled nursing facility – which provides both custodial care and skilled nursing care – provided the patient meets certain criteria. This includes having at least a three-day stay as a hospital inpatient before the stay in the skilled nursing facility. For the first 20 days in the skilled nursing facility, the patient doesn’t have to pay anything other than the Part A deductible they paid for the preceding inpatient stay. But there’s a daily copay for days 21-100.³

Does Medicaid cover long-term care?

Yes, Medicaid, which is a separate program for low-income Americans, administered jointly by the states and the federal government, does cover long-term care for people who have exhausted their resources.

Nearly two-thirds of nursing home residents in the United States have Medicaid coverage.⁴ Seniors who qualify for both Medicaid and Medicare are called dual-eligible. Their medical care is covered by Medicare, while their custodial care – including nursing home fees – and Medicare out-of-pocket costs are covered by Medicaid.⁵