Does Medicare Cover Long-Term Care or Nursing Home Care?

No. Medicare does not cover long-term care. Original Medicare pays for short-term skilled care after a qualifying hospital stay, intermittent skilled home health care, and hospice, but it does not pay for custodial care — the ongoing help with bathing, dressing, eating, and toileting that most people mean by long-term care.

That distinction explains almost every surprise families run into. Medicare is health insurance for treating illness and injury; long-term care is help with daily living. Below are the benefits, the day limits, why long-term custodial care is excluded by law, and the ways to pay families actually use. Figures are 2026 amounts published by CMS.

What “long-term care” means and which type of care Medicare covers

Long-term care is not a medical treatment. It is a set of long-term services and supports that help a person with the activities of daily living — bathing, dressing, eating, transferring in and out of bed, and using the toilet — plus related help such as meal preparation and housekeeping.

It is delivered in nursing homes, assisted living facilities, adult day care centers, and private residences. The setting does not change the answer: what matters is the type of care, not where it happens, because coverage turns on medical necessity.

Custodial care versus skilled care

Skilled care must be performed or supervised by licensed nursing or therapy professionals to be safe and effective — wound care, intravenous medication, tube feeding, or rehabilitation therapy after a stroke or joint replacement.
Custodial care is non-skilled help that does not require the continued attention of trained medical or paramedical personnel. Personal care of this kind is called custodial care, and CMS lists walking, getting in and out of bed, bathing, dressing, feeding, using the toilet, and supervising normally self-administered medication as examples.

Medicare may cover skilled care. Medicare will not cover custodial care. Because most long-term care is custodial, the practical answer for most families is that the program will not pay for the care they need.

Why does Medicare not pay for long-term care?

The exclusion is written into the statute. Section 1862(a)(9) of the Social Security Act, codified at 42 U.S.C. §1395y(a)(9), bars payment for expenses that “are for custodial care,” with a narrow carve-out for hospice. A separate provision limits Medicare to services reasonable and necessary to diagnose or treat illness or injury.

The program was enacted in 1965 as acute and post-acute health insurance, and Congress addressed the custodial need separately, through Medicaid. No amount of documentation or appeal changes this: Medicare will not pay for a stay whose only purpose is personal care.

What types of long-term care does Medicare cover?

Coverage here is real but narrow and conditional. There are four points where Medicare may help with long-term care needs.

1. Skilled nursing facilities: Medicare coverage after a qualifying hospital stay

Medicare Part A may pay for skilled care in a nursing facility, but only when every one of these conditions is met, according to Medicare.gov:

You have Part A and have days left in your benefit period.
You had a medically necessary inpatient hospital stay of at least 3 consecutive days. The admission day counts; the discharge day does not.
You enter a Medicare-certified skilled nursing facility within a short time of leaving the hospital. In practice this means entering the nursing facility within 30 days.
A doctor determines you need daily skilled nursing care or skilled therapy from or under the supervision of qualified professionals.
The skilled services treat a condition addressed during your hospital stay, or a new one that began while you were getting skilled nursing care for it.

Two conditions trip people up. First, time in the emergency room or under observation status does not count toward the three-day requirement; only formal inpatient admission counts. Second, the requirement is daily skilled care, so coverage ends once daily skilled services are no longer needed. This is the only circumstance in which Medicare will cover a nursing home stay.

2. Intermittent skilled home health care

Medicare covers home health care when a doctor or allowed practitioner certifies, after a face-to-face encounter, that you meet all of the following:

You are homebound — leaving home is not recommended because of your condition, or you need help to leave, and doing so takes a taxing effort.
You need intermittent skilled nursing care, or skilled physical therapy, speech-language pathology, or continued occupational therapy.
You are under a plan of care the certifying practitioner reviews and updates.
The services come from a Medicare-certified home health agency.

“Intermittent” has a specific meaning: combined skilled nursing and aide services are generally limited to fewer than 8 hours per day and 28 or fewer hours per week, with up to 35 hours for short periods when medically necessary. Aide help with bathing and dressing is covered only alongside skilled care. Medicare explicitly excludes 24-hour-a-day care at home, home-delivered meals, homemaker services, and personal care when that is the only care you need. You pay $0 for covered services and 20% of the approved amount for durable medical equipment.

3. Hospice care

Hospice is the one place Medicare will pay for short-term services resembling long-term care, and only at the end of life. You must have Part A; a hospice doctor and your regular doctor must certify a life expectancy of 6 months or less if the illness runs its normal course; and you must accept comfort care in place of curative treatment and sign a statement electing hospice.

Hospice runs in two 90-day benefit periods followed by unlimited 60-day periods, each requiring recertification. It covers nursing care, equipment and supplies, drugs for symptom control, aide and homemaker services related to the terminal illness, counseling, and short inpatient respite stays. You may pay up to $5 per outpatient prescription for symptom management and 5% of the approved amount for inpatient respite. Critically, hospice does not cover room and board, so in a nursing home the room and meals remain yours.

4. Outpatient therapy under Medicare Part B

Part B covers medically necessary outpatient physical, occupational, and speech-language therapy after the annual deductible, with 20% coinsurance. There is no hard dollar cap, but for 2026 CMS set a KX modifier threshold of $2,480 for physical therapy and speech-language pathology combined and $2,480 for occupational therapy, above which the provider must attest to medical necessity.

How much will Medicare pay towards a nursing home?

For Medicare to cover any part of a nursing home stay, the care must be skilled and daily. Medicare will pay for nursing home care only through the Part A benefit above, and skilled nursing facilities bill it on a sliding scale that runs out at 100 days. These are the 2026 amounts from the CMS premiums and deductibles fact sheet:

Days 1–20: Medicare covers the first 20 days in full. You pay $0 per day, after the Part A deductible of $1,736 per benefit period (not charged again if you already paid it during the hospital stay in the same benefit period).
Days 21–100: You pay $217 per day in coinsurance. Medicare pays the rest.
Day 101 and beyond: You pay all costs. Medicare pays nothing.

For context, 2026 inpatient hospital coinsurance is $434 per day for days 61–90 and $868 per lifetime reserve day; the Part B standard premium is $202.90 per month with a $283 annual deductible.

How the benefit period shapes nursing home coverage

The 100 days are counted per benefit period, not per year or per lifetime. Medicare defines a benefit period as beginning the day you are admitted as an inpatient to a hospital or skilled nursing facility, and ending once you have gone 60 days in a row without inpatient hospital care or skilled care in one.

There is no limit on the number of benefit periods. A new one resets the 100-day clock but also triggers a new Part A deductible: two hospitalizations more than 60 days apart in the same year mean paying $1,736 twice.

100 days is a ceiling: nursing home costs after coverage ends

The 100-day figure is widely misread as an entitlement. It is a maximum, and the day limits are strict. Medicare only covers days that are skilled and medically necessary, so it may only cover nursing home care for part of a stay — coverage ends the moment daily skilled care is no longer reasonable and necessary, often well before day 100. Once the need shifts from rehabilitation to help with daily living, the stay becomes custodial and payment stops, even on day 30. From that point the nursing home costs are yours.

One point runs the other way. Under the Jimmo v. Sebelius settlement, CMS confirmed that coverage of skilled nursing and therapy “does not turn on the presence or absence of a beneficiary’s potential for improvement, but rather on the beneficiary’s need for skilled care.” Skilled services may be covered to maintain a condition or slow decline, not only to improve it — though that did not extend the day limits.

What are the four things Medicare doesn’t cover?

Long-term care leads the list. Medicare.gov’s list of services Original Medicare does not cover includes:

Long-term care (custodial care), whether in a nursing home, an assisted living facility, or at home.
Most dental care, including routine cleanings, fillings, extractions, and dentures.
Eye exams for prescription eyeglasses, and the glasses themselves in most cases.
Hearing aids and the exams for fitting them.

The list also includes cosmetic surgery, massage therapy, routine physical exams, and concierge care. Separately, no Medicare benefit will help pay for the room and board portion of custodial care in a nursing home, help with bathing and dressing, supervision for cognitive decline or wandering, assisted living charges, adult day care, or homemaker services. Nursing home costs of that kind are not covered by Medicare, and nothing in Part A or Part B will cover the cost.

Do Medicare Advantage or Medicare Supplement plans cover long-term care?

Medigap policies help with the deductibles, copayments, and coinsurance of Original Medicare. Original Medicare doesn’t cover custodial long-term care, so there is no cost sharing for a Medigap policy to pick up, and Medicare Supplement plans don’t create the coverage on their own. Medicare.gov states that “Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don’t pay for long-term care services.” Prescription drug coverage under Medicare Part D applies to covered outpatient drugs but does not pay for long-term care either.

A Medicare Advantage plan is required by federal regulation to cover at least the same items and services Original Medicare covers, so the same statutory custodial care exclusion applies to the Part A and Part B benefits it delivers. Some plans may offer additional benefits; describing or comparing those is outside the scope of this educational page.

Ways to pay for long-term care

Because Medicare does not cover long-term nursing home stays, the cost falls elsewhere. The need is common: HHS research finds about 70% of adults who survive to age 65 develop severe long-term services and supports needs. Most people who need long-term care need help with daily living, not treatment, and these long-term care options each carry their own rules, so long term care coverage differs sharply between them.

Medicaid and long-term care

Medicaid and long-term care are tightly linked. Medicaid.gov states that “Medicaid is the primary payer across the nation for long-term care services.” It pays for long-term care in a nursing home and, in every state, for home and community based services that provide long-term care outside an institution.

It is means-tested: eligibility depends on a financial test (income and countable assets) and a functional test (a state determination of nursing home level of care), both set state by state.

In Florida this runs through the Statewide Medicaid Managed Care Long-Term Care program, beginning with a level-of-care determination by the Department of Elder Affairs CARES unit and screening through local Aging and Disability Resource Centers. Covered services include nursing facility care, assisted living, adult day care, attendant and personal care, respite, and home modifications.

Out-of-pocket funds and unpaid family care

Many families pay privately at first, drawing on savings, retirement income, or home equity; some use the cash value of a life insurance policy to pay for care. The out-of-pocket expense of a long stay can consume a substantial share of household assets. Families often combine that paid care with Medicare-covered skilled visits, plus unpaid help from spouses and adult children.

Private long-term care insurance

This is a separate product from health insurance, sold to cover the custodial care Medicare excludes. Policies are medically underwritten, typically require a waiting period and documented inability to perform a set number of daily activities, and pay a daily or monthly amount for a defined period. Terms differ substantially between products.

Other long-term care options: VA benefits and PACE

The United States Department of Veterans Affairs can provide long-term care to eligible veterans — nursing home, assisted living, home health aide, respite, and adult day health care — based on service-connected status, disability rating, income, and clinical need. Aid and Attendance and Housebound allowances can also raise a monthly VA pension.

The Program of All-Inclusive Care for the Elderly is a joint Medicare and Medicaid program covering nursing home care, personal care, adult day services, and transportation. To join you must be at least 55, live in a PACE service area, be certified by your state as needing a nursing home level of care, and be able to live safely in the community with PACE support. It does not operate everywhere.

Frequently asked questions

Does Medicare cover long-term care at home?

Not as custodial care. The services that Medicare will pay for at home are intermittent skilled nursing and therapy for homebound beneficiaries under a plan of care, and an aide can help with personal care alongside them. It does not cover a personal care aide, homemaker services, or around-the-clock care at home when help with daily living is all you need.

How long does Medicare cover nursing home care?

Up to 100 days per benefit period, and only for skilled nursing facility care following a qualifying 3-day inpatient hospital stay. Days 1–20 carry no daily coinsurance; days 21–100 cost $217 per day in 2026. Coverage ends earlier if daily skilled care is no longer needed.

What is the difference between skilled care and custodial care?

Skilled care requires the judgment and training of licensed nursing or therapy professionals, such as wound care or post-stroke rehabilitation. Custodial care is help with daily activities that a non-medical caregiver can provide. Medicare may cover the first and never the second.

Does Medicare cover assisted living?

No. Medicare does not pay assisted living charges, which are largely room, board, and personal care. If a resident separately qualifies for a covered service, such as a doctor visit or a skilled home health episode, Medicare pays for that service but not the facility.

What happens if an elderly person can’t afford a nursing home?

Medicaid is the program designed for this situation and is the primary payer for nursing facility care nationally. A person who meets their state’s financial and functional criteria can have nursing home care covered by Medicaid. Other paths include VA long-term care for eligible veterans, PACE where it operates, and state home and community based waivers. State Health Insurance Assistance Programs and Aging and Disability Resource Centers counsel on these at no charge.

Does Medicare pay for nursing home care without a hospital stay?

No. Without a medically necessary inpatient stay of at least 3 consecutive days, Part A does not cover a skilled nursing facility admission. Nights under observation status do not count, so confirm your admission status in writing while still in the hospital.

Do Medicare Supplement plans cover long-term care?

No. Medigap policies help with Original Medicare’s deductibles and coinsurance, including the $217 daily skilled nursing facility coinsurance under most plan letters. They do not create long-term care coverage, because Original Medicare does not cover custodial care.

How can you plan ahead for long-term care needs?

Planning generally involves understanding which care is covered and which is not, estimating long-term care costs in your area, learning your state’s Medicaid eligibility rules, documenting care preferences, naming a health care surrogate, and discussing expectations with family who may provide unpaid care. Because the financial, tax, and legal treatment of these decisions varies by household and state, they are matters for qualified professionals.

Disclosures

This page is educational and general in nature. It is not medical, financial, tax, or legal advice, and it is not a statement of benefits or a guarantee of coverage for any individual. Rules, cost-sharing amounts, and Medicaid eligibility criteria change and are administered by federal and state agencies; figures here reflect the 2026 amounts published by the Centers for Medicare & Medicaid Services. For details about your own coverage, check with Medicare at Medicare.gov or 1-800-MEDICARE, or contact your State Health Insurance Assistance Program. Lifeworth Insurance Agency is a trade name of Lifeworth Financial Group LLC, National Producer Number 21228343, licensed in Florida.

More on this: an overview of long-term care options.