Does Medicare Pay for Long Term Care Facilities?

It depends on your situation. Medicare does not pay for lengthy stays in nursing homes and other long-term care facilities. It also does not pay for short-term stays unless you were hospitalized first.

This is because most nursing homes and other long-term care facilities provide custodial services that aren’t covered. This includes help with bathing, feeding, dressing and other day to day activities.

The rules are different if you need skilled care after you have been in the hospital for at least three days. Medicare will pay the full cost of your care in a long-term care facility for up to 20 days.

After that, you must pay coinsurance each day ($167.50 in 2018), but Medicare will pay the rest for up to 100 days. Most Medicare Supplement Plans will pay this coinsurance for you. Skilled care might include such things as IVs and physical or occupational therapy.

If you are over 65, it’s likely you will need long term care at some point. This might be because of an illness, chronic condition or accident. Whatever the reason, long term care is expensive.

Does Medicare Pay for Long Term Care Facilities?

Genworth’s most recent cost of care survey estimates the median cost for an assisted living facility at $3750 a month, with a semi-private room in a nursing home running $8121.

Many people are surprised to learn that most long-term care costs are NOT covered by Medicare Parts A and B.

Here are answers to some of the most frequently asked questions about using Medicare to pay for long term care.

Does Medicare Pay for Long Term Home Care?

Medicare benefits for home care are limited. If you are home bound, Medicare will pay for some home health services ordered by your doctor, such as intermittent skilled nursing care and physical therapy.

It will also pay for durable medical equipment like a walker or oxygen.

However, Medicare does not pay for long term home care, assistance with daily tasks, cooking and cleaning services, or meals.

If you have a loved one who is near the end of life, Medicare will pay for hospice care, either in your home or in a facility.

Hospice provides a team of professionals to care for someone who is not expected to live more than six months.

Does Medicare Pay for Long Term Assisted Living?

No. Assisted living facilities provide help with day to day activities, and this is not covered by Medicare.

Does Medicare Pay for Long Term Nursing Care?

Medicare pays for skilled care in a long-term facility for up to 100 days after you have been discharged from a hospital stay lasting at least three days (see above). However, long term care in a nursing home is considered custodial care and is not covered by Medicare.

Does Medicare Pay for Long Term Memory Care?

Like long term nursing home care, long term memory care is custodial care not covered by Medicare. You can find more information on long term memory care here.

Does Medicare Pay for Long Term Acute Care?

Medicare pays for acute care in a long-term care hospital, using the same rules that apply to any other hospital stay. Long term care hospitals focus on patients who need more extensive care or more time to recover.

Medicare Part A covers the full cost of the first 60 days, after your deductible is met. After the 60th day, there is a daily copayment, and you will be responsible for all costs at some point after day 90, depending on the benefits you have used in the past.

However, if you have a Medicare Supplement plan, it will extend your coverage for an additional 365 days after Medicare benefits are used up.

If you have Medicare Advantage (Part C), your plan may offer other benefits in addition to those offered by Medicare Parts A and B, including additional long-term care coverage. Check with your plan to find out.

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