Medicare and Long-Term Care: What It Won't Pay and Your Options
Written by My65 Playbook Editorial Team
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If you need short-term rehab after a hospital stay, see our guide to observation versus admission and skilled nursing coverage instead.
Medicare does not pay for long-term custodial care, which is help with daily tasks like bathing and dressing, when that is the only care you need. It pays only for short-term skilled care. People cover long-term care with savings, Medicaid, long-term care insurance, veterans benefits or family help.
Key takeaways
- Medicare pays for short-term skilled nursing and home health care, not ongoing help with daily tasks.
- Custodial care in a nursing home, assisted living or your own home is not covered by Medicare.
- Medicaid pays for long-term care for people with limited income and resources who qualify.
- Long-term care insurance must usually be bought before you need care, and approval depends on your health.
- PACE and some veterans programs can help pay for care at home.
What is long-term care?
Long-term care is help with daily life over months or years. Much of it is custodial care (help with everyday tasks, not medical treatment). It can happen in a nursing home, an assisted living home or your own house.
The everyday tasks are often called activities of daily living. They include:
- Bathing and dressing
- Eating
- Using the bathroom
- Moving from a bed to a chair
- Walking around the home
People often need this help after a stroke, with memory loss such as dementia, or with frailty as they age. The help can come from paid aides or from family.
What does Medicare pay for?
- Skilled nursing facility careUp to 100 days after a 3-day inpatient stay
- Home health carePart-time skilled care if you are homebound
- Hospice careFor a terminal illness
Medicare pays for some care in a nursing facility or at home, but only short-term skilled care. Skilled care is care that trained staff such as nurses or therapists must give.
Skilled nursing facility care. After a hospital stay of at least 3 days as an inpatient, Part A can pay for up to 100 days in each benefit period. Days 1 to 20 cost $0. For days 21 to 100, you pay a daily coinsurance set each year.
Home health care. If you are homebound and need part-time skilled care, Medicare can pay for nursing and therapy at home. Learn the rules in Medicare Home Health Care.
Hospice care. For people with a terminal illness who choose comfort care, Medicare pays for hospice. See How the Medicare Hospice Benefit Works.
What does Medicare not pay for?
- Long-term nursing home stays for daily help
- Assisted living room and board
- Home aides when no skilled care is needed
- Round-the-clock care at home
- Homemaker services
Medicare does not pay for custodial care when it is the only care you need. That rule applies wherever you get it.
Medicare does not pay for:
- Long-term stays in a nursing home for help with daily tasks
- Room and board in assisted living
- Home aides for bathing, dressing or meals, when you need no skilled care
- Round-the-clock care at home
- Homemaker services, such as cleaning and shopping
Medigap policies follow Medicare's rules, so they do not pay for long-term custodial care either. Some Medicare Advantage plans offer extra in-home support, such as a few hours of help a month. These benefits vary by plan, location and carrier.
How does Medicaid help with long-term care?
Medicaid (a joint federal and state program for people with limited income and resources) pays for long-term nursing home care. It is the main public program that does. To qualify, your income and savings must be below your state's limits.
Many states also use Medicaid to pay for care at home or in the community. These are often called home and community-based services. They can include aides, adult day care and help with meals.
Medicaid looks back 5 years at money or property you gave away. Gifts made in that time can delay when Medicaid starts paying. After a Medicaid member dies, the state may seek repayment from their estate for care it paid for.
People with both Medicare and Medicaid keep their Medicare. Medicare pays first for covered care, and Medicaid helps with the rest. Medicare Savings Programs can also pay Part B premiums for people who qualify; see Medicare Savings Programs.
How do Medicare and Medicaid compare?
| Medicare | Medicaid | |
|---|---|---|
| Long-term nursing home care | Not covered | Covered for people who qualify |
| Short-term skilled nursing care | Up to 100 days per benefit period | May help with costs Medicare leaves |
| In-home help with daily tasks | Not covered | Covered in many states |
| Who qualifies | People 65 and older, and some younger people | Based on income and resources |
| Medicare | Medicaid | |
|---|---|---|
| Long-term nursing home care | Not covered | Covered for people who qualify |
| Short-term skilled nursing care | Up to 100 days per benefit period | May help with costs Medicare leaves |
| In-home help with daily tasks | Not covered | Covered in many states |
| Who qualifies | People 65 and older, and some younger people | Based on income and resources |
The key difference is custodial care. Medicare does not pay for it. Medicaid can, if you meet your state's income and resource limits.
Can long-term care insurance help?
- Buy before you need careInsurers review your health
- Check what settings it pays forNursing home, assisted living, home
- Note the waiting periodYou pay for care until it ends
- Expect premiums can rise
Long-term care insurance is private insurance that pays for custodial care. Policies can cover nursing homes, assisted living and care at home. What each policy pays, and for how long, depends on the policy.
You usually must buy it before you need care. Insurers ask about your health and can say no. Premiums are often lower when you buy at a younger age, and they can go up later.
Many policies have a waiting period before they start paying. During that time, you pay for care yourself. Some life insurance policies also include a long-term care benefit you can use while living.
What other help is there?
PACE (Program of All-Inclusive Care for the Elderly) helps people 55 and older who need nursing-home-level care but can live safely at home. It is open in some areas only. Medicare and Medicaid both help pay for it, and it coordinates medical and daily care.
Veterans benefits. The VA offers nursing home care and in-home help to some veterans. Some veterans and surviving spouses can get an extra monthly pension to pay for daily help.
Family and savings. Many people pay for care with savings, retirement income or the sale of a home. Family members often give unpaid care. Some states offer paid caregiver programs through Medicaid.
How can you plan ahead?
Long-term care costs can be large, and Medicare will not cover most of them. Planning early gives you more choices. Long-term care insurance, for example, is easier to get while you are healthy.
Decide with your family where you would want to receive care. Write down your income, savings and any insurance you have. Then compare that to the help each program offers.
Your Medicare costs continue while you get long-term care. In 2026, the Part A hospital deductible is $1,736 per benefit period. The 2026 standard Part B premium is $202.90 a month. Both are set each year.
Have questions? Call 1-877-443-3251 to talk it through with a licensed insurance agent. You never pay the agent; the plans they represent do, and the decision stays yours.
We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.
What to do this week
- Write down the daily tasks you or a family member need help with now.
- List your monthly income, savings and any long-term care or life insurance policies.
- Find your state's Medicaid income and resource limits for long-term care on your state Medicaid website.
- Search Medicare.gov for a PACE program serving your ZIP code.
- If you are a veteran or surviving spouse, find your discharge papers to check for VA long-term care help.
A real example
Medicare Disclaimer
We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Medicare has neither reviewed nor endorsed this information.
Frequently asked questions
Does Medicare pay for a nursing home?
Only for short-term skilled care, up to 100 days per benefit period after a 3-day inpatient hospital stay. It does not pay for long-term custodial care.
Does Medicare pay for assisted living?
No. Medicare does not pay for room and board or daily help in assisted living.
Will Medicare pay for a home aide?
Only as part of home health care when you are homebound and need part-time skilled care. Medicare does not pay for aides when daily help is the only care you need.
Does Medigap cover long-term care?
No. Medigap follows Medicare's rules, so it does not pay for long-term custodial care.
How does Medicaid pay for long-term care?
Medicaid pays for nursing home care and, in many states, care at home for people whose income and resources are below state limits. It looks back 5 years at gifts of money or property.
What is PACE?
PACE is a program for people 55 and older who need nursing-home-level care but can live safely at home. Medicare and Medicaid help pay for it, and it is offered in some areas only.
