Medicare will provide some coverage under Part A if you need long-term services as part of your care
You may receive long-term care coverage if the services are part of a larger care plan to treat a health condition or illness
If you receive skilled nursing care in a nursing home, you’ll need to meet Medicare requirements to get covered
Long-term care is also referred to as custodial care. Since these services don’t help treat an illness, they’re not covered by Medicare’s Parts A and B. Some Medicare Advantage plans may include long-term care benefits, but you may need to purchase a separate policy to cover long-term care or pay out of pocket when you need it.
You may receive Medicare long-term care coverage if those services are part of a larger care plan to treat a health condition or illness. If long-term care is your primary need, you’ll have to pay for the costs and services you receive.
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No, if you have Medicare and long-term care is the only service you need, it likely won’t be covered. Medicare doesn’t pay for you to stay at a long-term care facility if all you need is help with everyday living activities. [i]
Does Medicare pay for long-term care services under any circumstances? Yes, Medicare Part A can provide coverage for stays in skilled nursing settings. For example, if you have a stroke or suffer a severe injury, you may need inpatient, specialized rehabilitation. You can do this in a skilled nursing facility, a nursing home equipped for skilled nursing care, or in a hospital. In cases like these, Medicare will also pay to help cover the custodial (or long-term) care you receive as part of your treatment.
It doesn’t unless you receive these services as part of a treatment plan for a severe injury or health condition. For example: If you have a stroke, Medicare considers these treatments part of your care plan since you can’t perform them yourself. But there are limits to how long you can receive them before paying out of pocket, and the amounts increase with time.
In other words, there’s no such thing as total Medicare long-term care coverage.
If you or a loved one need help with daily living activities, you’ll need to pay for long-term care yourself. Here are some of the ways Medicare beneficiaries pay for their long-term care:
- Private funds: Many use retirement savings, financial assistance from relatives, or other private income to pay for long-term care.
- Long-term care insurance: Some people have long-term care insurance policies to help cover the costs of long-term care.
- Veteran’s Affairs: Military veterans may have access to long-term care benefits from the U.S. Department of Veterans Affairs.
- Medicaid: Medicaid eligibility varies by state but requires limited income and assets. If you qualify, your state may have programs to help pay for long-term care.
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As we mentioned, Medicare will provide some coverage under Part A if you need long-term services as part of your care. These can include rehabilitative treatments after an injury or stroke and must occur in a qualified skilled nursing facility. If you qualify, you can receive benefits for up to 100 days. [i] Here’s how Part A covers skilled nursing:
- Days 1-20 in each benefit period: $0
- Days 21-100 in each benefit period: $185.50 daily coinsurance
- Days 101 and beyond: You pay all costs
For Medicare long-term care to be included in your skilled nursing benefits, your care must meet specific criteria, including:
- You must receive it in a certified skilled nursing facility (SNF)
- You must have spent three consecutive days in a hospital
- You must be admitted to the SNF within 30 days of being discharged from the hospital
How much does Medicare pay for long-term nursing home care?
Some nursing homes are also equipped to provide skilled nursing care. If you receive skilled nursing care in a nursing home, you’ll still need to meet the requirements above. If you receive custodial, long-term care in addition to your skilled nursing care, Medicare may cover it. Otherwise, Medicare long-term care coverage will not pay for your stay in a nursing home.
Medicare coverage only includes long-term care services you receive as part of another treatment. Most long-term care isn’t medical care. It provides help with daily tasks like eating, getting dressed and bathing. Medicare may cover these services, but typically only if you need them as part of another treatment. This care is generally provided in specific locations, including skilled nursing facilities, nursing homes equipped for skilled nursing services, and hospitals.
What extra benefits and savings do you qualify for?
If you’re receiving skilled nursing care in an approved nursing home, Medicare Part A may cover a portion of your costs. That coverage may last up to 100 days, as outlined above. Other than that, Medicare generally won’t cover any part of nursing home care.
Some Medicare Advantage plans may offer additional coverage for nursing homes. To see if any plans in your area can help with long-term care, give GoHealth a call. Our licensed insurance agents will discuss your needs. Medicare long-term care coverage is available with any Medicare Advantage plans near you.