Most Medicare enrollees are either 65 and older or have a qualifying disability. Of those beneficiaries many will need some type of long-term care during their lifetime.

The harsh reality is that the out-of-pocket costs for long-term care can become very expensive considering seniors are now living longer lives due to advancements in pricey healthcare; underscoring the importance of understanding what Medicare will help pay for.

What does long-term care involve?

Roughly 70% of people age 65 and over will need some type of long-term care before they die, as reported by the U.S. Department of Health and Human Services.

Long-term care can involve different types of living arrangements and care, such as:

Skilled nursing homes: A skilled nursing home may provide some medical care, such as rehabilitation services, including physical and occupational therapy. Nursing homes also provide:

  • 24-hour supervision
  • Meals
  • Activities, such as crafts and games
  • Three meals a day
  • Assistance with activities of daily living, such as bathing and toileting

Some people reside in a nursing home short-term as they recover from an illness or accident. But according to the National Institute on Aging, most nursing home residents live there permanently due to ongoing needs.

Assisted living facilities: Assisted living facilities do not provide as much nursing care as skilled nursing facilities. The exact services or level of care provided may vary. But they typically offer services, such as:

  • Meals
  • Housekeeping
  • 24-hour supervision
  • Help with medications
  • Social and recreational activities
  • Laundry

For more information visit Does Medicare Pay For Assisted Living?

In-home care: In-home care helps someone continue to live in their own home safely. In-home services may vary according to individual needs. It may include:

  • Help with medical care
  • Assistance with bathing and grooming
  • Meal preparation

Does Medicare cover nursing home costs?

Medicare does cover some skilled nursing care, including a short stay in a skilled nursing home when the care involved includes medical care. For example, if someone had an illness and required care after getting discharged from an acute care hospital, Medicare may cover the costs up to a certain length of stay.

Medical care involves care from a skilled or licensed medical professional. The medical care covered services may include the following:

  • Physical, speech, or occupational therapy
  • Pain management
  • Wound care
  • Medication administration

Keep in mind that short-term nursing home costs differs from long-term care. According to, Medicare typically does not cover long-term care services when it is the only care a person needs.

For instance, if an individual needs long-term care to assist with everyday activities like meals and bathing, Medicare does not cover costs. Medicare considers this type of care custodial care or non-medical care, in which most people pay for this out of pocket with the help of long term-care-insurance.

Medicare also does not cover long-term care if a person has medical needs due to a chronic condition. For instance, if someone has dementia and requires a combination of medical and custodial care, Medicare does not cover nursing home costs.

For more information visit Medicare Coverage for Alzheimer’s and Dementia Patients.

Available coverage from Medicare

The available coverage from Medicare is determined according to specific criteria. Medicare Part A will cover the costs of long-term care for a limited amount of time in the following circumstances:

  • The care needed is to aid in recovery from an illness or injury. It is not due to a long-term condition. For example, someone requiring care after a car accident as opposed to care due to a chronic disease.
  • The individual has had a minimum of a three-day stay in the hospital right before needing long-term care. Medicare does not pay if someone was admitted into a nursing home directly from their own home.
  • A doctor must order medical care from the skilled nursing staff or therapy staff, such as physical therapy.
  • An approved skilled nursing facility must provide the care.

The amount Medicare Part A covers includes the following:

  • The first 20 days of a skilled nursing home stay: Medicare covers 100% of the cost. Medicare recipients have $0 coinsurance.
  • Days 21 to 100 of a stay: Medicare covers most of the costs. But as of 2022, recipients may have a co-pay of up to $194.50 per day.
  • Day 101 plus: Medicare Part A does not cover any of the costs. Medicare beneficiaries cover all costs.

According to the Centers for Medicare and Medicaid Services, if you qualify for a Medicare-covered nursing home stay, they cover the following services:

  • Skilled nursing care
  • A semi-private room
  • Speech, physical, and occupational therapy
  • Meals
  • Medical supplies and equipment
  • Medical social services

How does a benefit period affect Medicare coverage?

Medicare uses a benefit period to determine if someone is eligible to receive skilled nursing home coverage. A benefit period starts when someone begins skilled nursing care or on the first day of an inpatient hospital stay. A Medicare recipient may receive up to 100 days of coverage if the above criteria are met in a benefit period.

The end of a benefit period is when someone is out of the hospital or skilled nursing home for 60 days in a row. Once someone is out of their benefit period, they may qualify for a subsequent short stay in a skilled nursing home if they have another 3-day hospital stay and meet the other Medicare requirements for nursing home coverage.

Exceptions involving hospice care

One exception to long-term care that Medicare covers is hospice. Hospice involves care for someone that is terminally ill and expected to die within six months. Hospice may include inpatient care or at-home services.

Medicare covers 100% of hospice-related services, which may include:

  • Medications
  • Nursing care
  • Bathing and dressing
  • Social service assistance

Medicare Part A covers long-term care under hospice if the following criteria are met:

  • Certification from a doctor that someone has a life expectancy of six months or less
  • Acceptance of palliative care (care for comfort), not care to cure the condition

What about Medicare Advantage plans?

Some people may select a Medicare Advantage plan as an alternative to original Medicare. If you have a Medicare Advantage plan, you will have the same coverage as someone that is covered under Medicare Part A.

Although Medicare Advantage plans differ in their coverage, they cover long-term care the same as Medicare Part A. The same requirements that apply to qualifying coverage by Medicare Part A, also apply to advantage plans.


  1. Hospice Care Coverage, Medicare. 
  2. Long-Term Care Coverage, Medicare. 
  3. Medicare Coverage of Skilled Nursing Facility Care, Medicare. 
  4. Residential Facilities, Assisted Living, and Nursing Homes, National Institute on Aging.
  5. Lifetime Risk of Needing and Receiving Long-Term Services, ASPE.