Medicare or Medicare Advantage Pay for Long Term Care?
Medicare Advantage may cover skilled nursing care and may offer certain additional benefits.
Shanti
9/5/20264 min read
Does Medicare or Medicare Advantage Pay for Long Term Care?
One of the common misconceptions about Medicare is that if someone needs a nursing home or long term care during retirement, Medicare will pay for all of the costs. In most cases, however, that is not true.
Medicare may cover certain medical and care services under specific conditions, but long term care or ongoing custodial care is generally not covered by Medicare.
What Is Long Term Care?
Long term care usually refers to care needed when a person requires ongoing assistance with activities of daily living, such as:
• Bathing
• Dressing
• Eating
• Using the bathroom
• Moving from one place to another
• Daily supervision and assistance
• Living in a nursing home or assisted living facility
These types of services are generally referred to as custodial care.
If the main reason someone is staying in a care facility is that they need help with daily activities, Medicare generally does not pay for the cost of long term residence in that facility.
What May Medicare Cover?
Original Medicare may cover care in a Skilled Nursing Facility for a limited period of time under certain conditions.
For example, after a hospital stay, a person may need rehabilitation, physical therapy, skilled nursing services, or other specialized medical care. In these situations, Medicare may help cover the cost for a limited number of days during each benefit period.
The important point is this:
Short term skilled nursing care is different from long term care.
The purpose of skilled nursing care is generally treatment, rehabilitation, or helping the patient recover, rather than paying for someone to live permanently in a nursing home.
Does Medicare Advantage Provide More Help?
Medicare Advantage, also known as Part C, must provide at least the services covered by Original Medicare.
Therefore, if a person qualifies for skilled nursing care or rehabilitation, a Medicare Advantage plan may also cover these services according to the rules of the plan.
However, Medicare Advantage also generally does not pay for ongoing long term custodial care.
Simply put:
Having Medicare Advantage does not mean that several months or several years of nursing home care will be fully paid for.
However, some Medicare Advantage plans offer additional benefits that may not be available through Original Medicare.
Depending on the plan, these additional benefits may include services such as:
• Limited assistance with certain in home services
• Transportation
• Meal delivery
• Certain support services after discharge from the hospital
• Special benefits for some people with chronic health conditions
These benefits are not the same in every Medicare Advantage plan, and eligibility requirements and coverage rules may vary from one plan to another.
What Role Does Medicaid Play in Long Term Care?
Medicaid can play a much larger role when it comes to long term care.
People who meet Medicaid requirements related to income, assets, and other eligibility rules may be able to receive help paying for some or a significant portion of long term care expenses.
These services may include nursing home care and, in some situations, care provided at home or in the community.
However, Medicaid eligibility has specific rules, and those rules may vary depending on the state and the individual’s circumstances.
What Happens If Someone Has Both Medicare and Medicaid?
People who qualify for both Medicare and Medicaid are generally referred to as dual eligible individuals.
In these situations, Medicare typically pays first for medical services that it covers, while Medicaid may help pay for certain costs and services that Medicare does not cover.
For some individuals, a D SNP, or Dual Eligible Special Needs Plan, may also be an appropriate option.
Even in these situations, it is important to carefully determine which services are covered by Medicare, Medicare Advantage, Medicaid, or other programs.
What Role Does Long Term Care Insurance Play?
People who do not want to pay the full cost of long term care from their personal savings may want to consider Long Term Care Insurance.
This type of insurance is specifically designed to help pay for certain expenses that Medicare generally does not cover, including some services such as:
• Nursing home care
• Assisted living
• Home health care
• Personal care
The waiting period, benefit amount, length of coverage, and other policy provisions can vary significantly from one insurance policy to another.
A Simple Way to Remember the Differences
Original Medicare
Original Medicare may cover short term skilled nursing care and rehabilitation under certain conditions, but it generally does not cover ongoing long term custodial care.
Medicare Advantage
Medicare Advantage may cover skilled nursing care and may offer certain additional benefits, but it is generally not a replacement for Long Term Care Insurance.
Medicaid
For eligible individuals, Medicaid may play an important role in helping pay for long term care and nursing home services.
Long Term Care Insurance
Long Term Care Insurance is designed to help cover the cost of long term care services.
An Important Consideration for Retirement
Having Medicare does not mean that all health and care expenses during retirement will automatically be covered.
An important part of retirement planning is understanding in advance how the cost of long term care would be paid if it is ever needed.
Medicare, Medicare Advantage, Medicaid, and Long Term Care Insurance each serve different purposes, and the most appropriate option depends on factors such as health needs, income, assets, location, and personal circumstances.
Before making any decisions, it is important to carefully review the Summary of Benefits and Evidence of Coverage for a Medicare Advantage plan, as well as the Medicaid eligibility requirements in your state.
Contact Us
Reach out anytime for personalized support
Phone
© 2025. All rights reserved.