Many older Americans are shocked to learn that Medicare—the federal health insurance program for those 65 and older—does not cover long-term care or assisted living in most cases.
While the program offers broad benefits for hospital stays, doctor visits, and prescriptions, it falls short when it comes to daily custodial care, the kind of support millions of seniors eventually need.
What Medicare Does Cover
Medicare is designed to cover medical necessities, not living assistance. Here’s what traditional Medicare (Parts A and B) typically includes:
- Hospital care (inpatient stays, surgeries)
- Short-term rehabilitation (in a skilled nursing facility after hospitalization)
- Doctor visits and outpatient care
- Durable medical equipment (wheelchairs, walkers)
- Home health care (under strict eligibility criteria)
- Prescription drugs (under Part D or a Medicare Advantage plan)
But there’s a catch: coverage for skilled nursing care is limited to 100 days following a qualifying hospital stay. After that, the bills fall to the patient or their family.
What’s Not Covered: Assisted Living and Custodial Care
Medicare does not cover:
- Long-term residence in assisted living facilities
- Non-medical custodial care, like help with bathing, dressing, and eating
- Memory care for Alzheimer’s or dementia
- Private rooms in nursing homes (unless medically necessary)
This gap leaves many seniors and their families unprepared—and often financially overwhelmed—when faced with long-term care decisions.
Who Pays for Long-Term Care?
When Medicare stops paying, options become limited:
- Medicaid (not to be confused with Medicare) may help cover long-term care—but only after seniors “spend down” their assets to qualify.
- Out-of-pocket payments are common, with costs averaging over $4,500 per month for assisted living in the U.S., and even higher for skilled nursing or memory care.
- Long-term care insurance can help, but policies are expensive and often need to be purchased well before care is needed.
Why the Confusion Over Long-Term Care and Medicare?
A recent survey found that more than half of Americans aged 60 and up believe Medicare will cover assisted living. That’s a costly misunderstanding.
The reality is that Medicare focuses on short-term, medical care—not the ongoing support required by those living with chronic illnesses or disabilities.
Planning Ahead is Crucial
Experts urge seniors and their families to start preparing early:
- Review Medicaid eligibility rules in your state
- Consult a financial planner or elder law attorney
- Research long-term care insurance before retirement age
- Understand the limits of Medicare coverage by visiting ssa.gov/medicare
The Bottom Line
Medicare is not a long-term care solution.
While it provides vital health benefits, it won’t foot the bill for assisted living or custodial care.
For the 7 in 10 seniors expected to need long-term care at some point, early planning could make all the difference.
Stay informed and protect your health. Medicare and Medicaid provide essential coverage for over 150 million Americans — understanding your eligibility, benefits, and upcoming policy changes is vital to maintaining access to care.
For personalized assistance or the latest updates, visit Medicare.gov, Medicaid.gov, or call 1-800-MEDICARE (1-800-633-4227).
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