Medicare Long-Term Care Benefits: A Simple Guide for Seniors

  • Medicare does not pay for long-term custodial care in a nursing home.
  • Medicare Part A may cover short-term skilled nursing facility (SNF) care after a qualifying hospital stay.
  • Medicare covers medically necessary home health care if you are homebound and need intermittent skilled care.
  • Medicare covers hospice if you have a terminal illness with a life expectancy of six months or less and choose comfort-focused care.
Need help choosing the right path? Call our licensed advisors for a free Medicare long‑term care review.

What Medicare Covers for Nursing Homes (Skilled Nursing Facility/SNF)

Who qualifies under Original Medicare (Part A)

  • You had an inpatient hospital stay of at least three consecutive midnights (observation status does not count).
  • Your doctor orders daily skilled care (e.g., skilled nursing or therapy).
  • You transfer to the SNF soon after the hospital stay for the same condition.
  • The facility is Medicare-certified.

How long Medicare may pay

  • Up to 100 days per benefit period when all criteria are met.
  • Days 1–20: generally $0 coinsurance.
  • Days 21–100: daily coinsurance applies (amount set by Medicare each year).
  • Coverage ends earlier if skilled care is no longer medically necessary or you stop improving.

What’s covered

  • Semi-private room, meals, nursing care.
  • Medications and medical supplies related to your skilled treatment.
  • Physical, occupational, and speech therapy when medically necessary.

What’s not covered

  • Long-term custodial care (help with bathing, dressing, eating) when that is the only care you need.
  • Private room (unless medically necessary) and personal convenience items.

Why Medicare often stops before 100 days

  • You no longer need daily skilled care.
  • Your condition has stabilized and can be managed at a lower level of care.
  • Documentation does not support continued skilled need.
Tip: Ask your hospital discharge planner to confirm your inpatient status (not observation), a qualifying three-midnight stay, and the written skilled care plan for the SNF.
Senior woman discussing Medicare Advantage nursing home coverage with a representative and nurse in a care facility.

Nursing Home Coverage Under Medicare Advantage (Part C)

  • Many plans do not require a three-day hospital stay but often require prior authorization.
  • Network rules and daily copays may apply (sometimes from day one).
  • The plan decides how many days it will authorize based on medical necessity.
  • Always review your plan’s Evidence of Coverage and get approvals in writing.

Medicare Home Health Coverage

Who qualifies

  • You are under a doctor’s care and have a written plan of care.
  • You need intermittent skilled nursing care or skilled therapy (PT/OT/ST).
  • You are homebound (leaving home requires considerable effort and is infrequent).
  • Care is provided by a Medicare-certified home health agency.

What’s covered

  • Skilled nursing and/or therapy.
  • Home health aide services for personal care when you also receive skilled care.
  • Medical social services.
  • Certain durable medical equipment (DME) under Part B (e.g., walker, hospital bed).

What’s not covered

  • 24/7 care at home.
  • Meal delivery and routine housekeeping.
  • Custodial care only (when no skilled need exists).

Costs

  • $0 for covered home health services.
  • 20% coinsurance for DME under Part B (after the Part B deductible).

Medicare Advantage and home health

  • Prior authorization and network agencies are common.
  • Visit limits or utilization review may apply—confirm with your plan.

Medicare Hospice Benefit

Who qualifies

  • You have Medicare Part A.
  • Your doctor and the hospice medical director certify a life expectancy of six months or less if the illness runs its normal course.
  • You choose hospice care (comfort-focused) instead of curative treatment for the terminal condition.
  • You receive care from a Medicare-certified hospice.

Where hospice is provided

  • Your home, a nursing facility, assisted living, or an inpatient hospice facility.

What’s covered

  • A team-based approach: nurses, physicians, social workers, chaplains, aides, and volunteers.
  • Medications, supplies, and equipment related to the terminal illness.
  • Short-term inpatient care for symptom management.
  • Respite care (up to 5 days at a time) to give family caregivers a break.

What’s not covered

  • Curative treatments for the terminal condition after you elect hospice.
  • Room and board in a facility (except short-term inpatient or respite stays).

Costs

  • Usually $0 for hospice services.
  • Small copay for outpatient prescription drugs and a coinsurance for inpatient respite care.

Benefit periods

  • Two 90-day periods, followed by an unlimited number of 60-day periods with ongoing recertification of eligibility.

When to consider hospice

  • When the focus shifts to comfort and quality of life.
  • Appropriate for advanced dementia, frailty, heart or lung disease, cancer, and other life-limiting illnesses—earlier is often better.

How to Get the Right Care and Coverage (Step-by-Step)

  1. Clarify your goal: recovery and rehab, care at home, or comfort-focused care.
  2. Talk to your doctor or discharge planner about eligibility and the care plan (SNF, home health, hospice).
  3. For Medicare Advantage, confirm network providers, prior authorizations, and daily copays.
  4. Request everything in writing: plan of care, expected length of treatment, and costs.
  5. If coverage is denied or ends early, ask for a written denial and appeal rights; contact your State Health Insurance Assistance Program (SHIP).
  6. If long-term custodial care is likely, schedule a Medicaid/long-term care planning consult.

Documents to Gather

  • Medicare card and any Medicare Advantage or Medigap information.
  • List of medications and medical history.
  • Hospital discharge summary or doctor’s notes.
  • Power of attorney and advance directives.

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Frequently Asked Questions

What is the difference between home health and home care?
Home health is short‑term medical care ordered by a doctor and may include nursing and therapy. Home care (non‑medical) covers daily living help like bathing, meals, and companionship.
How many hours of help can I get?
You can schedule from a few hours per week to 24‑hour support. Medicare home health visit lengths are time‑limited and based on clinical needs; non‑medical care is flexible and based on your preferences.
Am I “homebound” for Medicare?
You may still qualify as homebound if it’s difficult and taxing to leave home and you do so infrequently or for short, necessary trips (e.g., medical visits, brief family events). Your doctor determines eligibility.
Can I receive both home health and personal care at the same time?
Yes. Many families combine Medicare‑covered home health with privately paid personal care for fuller support.
Who pays for non‑medical home care?
Common options include private pay, Medicaid waivers (in many states), Veterans programs, and long‑term care insurance.
Is telehealth real home care?
Telehealth can complement in‑person visits with remote check‑ins and monitoring. It does not replace hands‑on personal care.
How soon can services start?
In many areas, non‑medical care can begin within 24–72 hours after your assessment. Medicare home health start times vary based on doctor orders and agency capacity.