The short answer
Medicare does not pay for long-term care. Its own coverage page is headed Not Covered and says you pay all costs. Most long-term care is help with everyday tasks rather than medical treatment, and Medicare names Medicaid and private long-term care insurance as the other routes.
You go to Medicare's own page about long-term care expecting to find what it costs. The heading says Not Covered. The line underneath says you pay all costs. And when you open the part that should tell you what to do next, it hands you a list of nine places to call.
Does Medicare cover long-term care?
No. Medicare's long-term care page is headed Not Covered and its status line says you pay all costs. The page then says what long-term care is, and most of it is help with everyday tasks rather than medical treatment. That is the reason Medicare itself gives for not paying.
Medicare makes that link itself rather than leaving it to be worked out. Its sentence begins with the word Since: since most long-term care is non-medical, Medicare and most health insurance do not pay for long-term care services, including care in a nursing home or in the community.
The definition it uses is wide. Long-term care, which Medicare also calls custodial care or long-term services and support, includes medical and non-medical care for people who have a chronic illness or disability.
Then it narrows to what most of it actually is. Most long-term care helps with basic personal tasks of everyday life, sometimes called activities of daily living.
Medicare names four of those tasks: help with personal care assistance, such as dressing, bathing and using the bathroom, home-delivered meals, adult day health care, and transportation.
What is the difference between skilled and custodial care?
Medicare draws the line at whether the care is medical. Its page says long-term care is different from skilled nursing facility care, and that most long-term care is non-medical. Custodial care is its own word for the same thing, and it covers dressing, bathing and using the bathroom.
Custodial is not a separate category on this page. It is one of the three names Medicare gives to the same thing in the same sentence, alongside long-term care and long-term services and support.
The building does not decide it either. Medicare states you can get non-medical long-term care services at home, in the community, in an assisted living facility, or in a nursing home.
So the same help, given in four different settings, stays outside the benefit in all four. The line Medicare draws here is about the kind of care, not about the address.
Skilled nursing facility care is a separate benefit with its own page in this publication, and that is where its rules belong rather than here.
What does Medicare actually pay for?
Medicare pays for care that is medical. Its long-term care page names skilled nursing facility care as the thing long-term care is different from, and this publication carries that benefit, home health care and hospice in full elsewhere. None of them is a way to pay for help with everyday living on its own.
Those are separate benefits with separate conditions, and each has its own page here. Reading any of them as a way to fund long-term care is the mistake this page exists to head off.
What puts long-term care outside all of them is the line the definition above already draws. Most of it is non-medical, and that is the reason Medicare itself gives.
So the page about long-term care is a page about who pays rather than a page about what Medicare pays, which is why the rest of this article is about the first question.
Who pays for custodial care?
You do, unless something else steps in. Medicare's page says you pay all costs for non-covered services, and it names two other routes: Medicaid if you meet your state's requirements, or private long-term care insurance you choose to buy. It states no amount for any of them.
| Who pays | What Medicare's page says | The trap |
|---|---|---|
| You | You pay all costs for non-covered services | Waiting for a benefit that is not there |
| Medicaid | If you meet the requirements in your state | Assuming one national rule applies |
| Private insurance | Something you can choose to buy | Reading a private policy as a Medicare benefit |
Behind that page sits a drawer that does not appear until you open it, and it is the most useful thing on the page. It is a table with nine rows, and each row answers a different question about long-term care with somewhere to go.
Call it Nine Rows, No Numbers. Planning goes to the Administration for Community Living. Insurance information goes to your State Insurance Department, or to the Medicare helpline to get that number. Qualifying for Medicaid goes to your State Medical Assistance office.
A shopper's guide to long-term care insurance comes from the National Association of Insurance Commissioners. Home and community based services go to Medicare-covered home health services or your local Area Agency on Aging, and Medicare notes that Medicaid may also cover some of them.
Subsidized senior housing goes to state and federal programs that help pay for housing for some seniors with low to moderate incomes. Continuing Care Retirement Communities go to your local Area Agency on Aging, with an instruction attached: check the quality of the community's nursing home and its inspection report, which is posted in the facility.
Group living arrangements go to the Eldercare Locator. And the ninth row is PACE, which Medicare describes as a Medicare and Medicaid program that helps people meet health care needs in the community instead of going to a nursing home or other facility.
Nine rows, nine destinations, and across the whole page, both drawers open, not one income limit, asset limit, premium or daily rate. The table is the government's and so is the silence. Naming that the page which tells you to pay for everything never tells you what everything costs is ours.
What role does Medicaid play?
Medicare's page says you may be eligible for long-term care through Medicaid if you meet the eligibility requirements in your state. It gives you one instruction for finding out, which is to call your State Medical Assistance office. It publishes no income limit and no asset limit.
The words in your state are doing the work in that sentence. Medicare does not describe one rule here, it describes a rule that is set somewhere else and differs by where you live.
That is why this page carries no figure for it. Publishing a national income limit or asset limit would be inventing a single answer to a question that has one answer per state, and the source this page is built on states neither.
Medicaid also turns up in a second row of the same table, where Medicare notes it may cover some home and community based services. That is a pointer to ask about, not a coverage statement.
What Medicaid pays for once you qualify is a subject of its own, and this publication carries it in the Costs section rather than here.
What about long-term care insurance?
Medicare names it as something you can choose to buy, and then tells you where to ask about it. Your State Insurance Department, or the Medicare helpline for that number, and a shopper's guide published by the National Association of Insurance Commissioners. It quotes no price.
That is the whole of what the government says about it on this page. It is named as an option and routed to a regulator, and nothing on the page describes what such a policy covers or excludes.
The guide is worth asking for by name. Medicare names the guide itself and the body that publishes it, so you can ask for a specific document rather than for advice in general.
Medicare does attach one line about timing, and it belongs to the reader rather than to the product. It says it is important to start planning for non-medical long-term care now, to maintain your independence and make sure you get the care you may need, in the setting you want, now and in the future.
There is one more instruction on the page for a specific group. If you are an American Indian or Alaska Native, Medicare says to contact your local Indian health care provider for more information.
What this means for you
Medicare does not pay for long-term care, and its own page says so in the heading. What it pays for instead is medical care with a clock on it. The page that tells you to pay all costs answers the money question with nine rows of places to call and no figure at all.
The line it draws is medical against non-medical, not home against facility. The same help with dressing and bathing sits outside the benefit whether it happens in your house or in a nursing home.
For the medical care that Medicare does pay for, the Coverage section carries skilled nursing facility care, home health care and hospice, and the Costs section carries how Medicaid and Medicare work together for people who have both.
FAQ
What actually counts as long-term care?
Medicare gives it three names in one sentence and then describes it. It calls it long-term care, custodial care, and long-term services and support, and says it includes medical and non-medical care for people who have a chronic illness or disability.
It then narrows to what most of it is in practice: help with the basic personal tasks of everyday life, sometimes called activities of daily living. The four examples it names are personal care assistance such as dressing, bathing and using the bathroom, home-delivered meals, adult day health care, and transportation.
Where that help happens does not change the answer. Medicare states you can get non-medical long-term care services at home, in the community, in an assisted living facility, or in a nursing home, and it sits outside the benefit in every one of them.
Who can help me work out my options if I am in hospital right now?
Medicare answers this in a drawer on its own page, and it names three kinds of help. If you are currently in a hospital, a nursing home, or working with a home health agency, it says you can get support to help you understand your long-term care options or to help you arrange care.
You can talk to a discharge planner. You can talk to a social worker. Or you can talk to an organization in what Medicare calls a No Wrong Door System, and it gives three examples of those: an Aging and Disability Resource Center, an Area Agency on Aging, or a Center for Independent Living.
That is the whole of what the page says on this, and it names the three routes rather than describing what each one does.
What is PACE?
It is one of the nine rows in Medicare's routing table, and Medicare describes it in a single line. PACE stands for Program of All-inclusive Care for the Elderly, and Medicare calls it a Medicare and Medicaid program that helps people meet health care needs in the community instead of going to a nursing home or other facility.
The page names it as somewhere to learn more about rather than describing how it works, who runs it, or where it operates.
This page does not go further than the source does, so nothing is said here about how you qualify for it or whether it is available where you live. Those are questions for the program itself and for the routes above.
Why does this page not tell me the Medicaid income limit?
Because Medicare's page does not state one, and this publication does not publish figures it cannot source. The sentence Medicare uses is that you may be eligible for long-term care through Medicaid if you meet the eligibility requirements in your state, and the instruction attached to it is to call your State Medical Assistance office.
Across the whole page, including both of its drawers, there is no income limit, no asset limit, no premium and no daily rate. A single national number would be describing one rule where the government describes fifty, so the honest answer is the phone call rather than the figure.
Does Medicare say anything about housing or retirement communities?
Yes, two of the nine rows are about exactly that. For subsidized senior housing, Medicare points to state and federal programs that help pay for housing for some seniors with low to moderate incomes, and it notes that some of those programs also offer help with meals and other activities such as housekeeping, shopping and laundry.
For Continuing Care Retirement Communities, which it describes as communities offering different levels of housing and care, it says to contact your local Area Agency on Aging for a list in your area.
It attaches one instruction to that row: if you are considering one, check the quality of its nursing home and its inspection report, which is posted in the facility.
