Key Takeaways:

• Medicare provides limited coverage for long-term care, which may leave you or your family responsible for significant costs. Understanding what Medicare covers—and what it doesn’t—can help you prepare financially.

• Exploring alternative options like Medicaid, supplemental insurance, or personal savings can prevent unexpected financial burdens as you age.

What You Need to Know About Medicare and Long-Term Care Coverage

Long-term care is something most people don’t think about until they need it. But as you get older, the potential costs can be staggering, and Medicare won’t always cover what you expect. If you’re planning for your future healthcare needs, it’s crucial to understand how Medicare fits into the picture and where it falls short. Here are six essential questions to ask before long-term care becomes a financial challenge for you or your loved ones.

1. Does Medicare Cover Long-Term Care Services?

The short answer? Not really. Medicare primarily covers short-term medical care rather than long-term custodial care. While it does cover skilled nursing facility (SNF) care under specific conditions, it doesn’t pay for extended stays in nursing homes, assisted living facilities, or in-home personal care services that aren’t medically necessary.

Medicare Part A covers up to 100 days in a skilled nursing facility, but only if you meet all eligibility requirements, including a prior hospital stay of at least three days. After the first 20 days, daily copayments apply. Once you reach day 101, Medicare coverage stops, and you’re responsible for the full cost.

What About Home Health Care?

Medicare does cover some home health care, but only when medically necessary. It must be prescribed by a doctor and typically includes skilled nursing care, therapy services, and home health aides for a limited period. However, if you need help with daily activities like bathing, dressing, or eating, Medicare won’t cover those costs unless they’re part of a broader medical treatment plan.

2. How Much Could Long-Term Care Cost Me Without Medicare’s Help?

The costs of long-term care services can add up quickly. According to national estimates, the average cost for a private nursing home room exceeds $100,000 per year in 2025. Assisted living facilities and in-home care services also come with significant expenses, depending on the level of care required.

Planning for Out-of-Pocket Expenses

Since Medicare doesn’t cover most long-term care costs, you may need to consider other options. Some people use personal savings, while others look into long-term care insurance, Medicaid, or hybrid insurance policies that include long-term care benefits. Without a plan, the financial impact on you or your family could be overwhelming.

3. Can Medicaid Help Cover Long-Term Care Costs?

Medicaid is a state and federal program designed to assist low-income individuals with healthcare expenses, including long-term care. However, it has strict income and asset limits. You must meet financial eligibility requirements before Medicaid will step in to cover nursing home care or in-home services.

Medicaid Spend-Down Rules

If your income or assets exceed Medicaid’s limits, you may need to “spend down” your savings to qualify. This process involves using your assets to pay for medical expenses until you reach the Medicaid eligibility threshold. Each state has different rules, so it’s essential to understand how Medicaid works in your area before relying on it for long-term care.

4. What Are the Alternatives If Medicare Won’t Pay for Long-Term Care?

If you’re worried about long-term care costs, you’re not alone. Many people explore alternative solutions to help cover these expenses, such as:

• Long-term care insurance: This type of policy covers nursing home stays, assisted living, and home care services. However, premiums increase with age, so buying early can be more cost-effective.

• Hybrid life insurance with long-term care benefits: Some policies allow you to use life insurance benefits to cover long-term care expenses.

• Personal savings and investments: Some retirees set aside funds specifically for future care needs.

• Family caregiving support: Some people rely on family members for assistance, but this can put an emotional and financial strain on loved ones.

5. When Should You Start Planning for Long-Term Care?

The earlier, the better. Waiting until you need care can severely limit your options. If you’re in your 50s or 60s, now is the time to consider long-term care planning. This allows you to explore different funding options, purchase insurance while premiums are still affordable, and prepare your family for potential future needs.

Questions to Ask Yourself

• How will I pay for long-term care if I need it?

• Do I want to stay at home as long as possible, or would I prefer an assisted living community?

• Will my spouse or children be financially or physically able to care for me?

• Am I eligible for Medicaid or other assistance programs?

6. How Can You Protect Your Assets While Ensuring You Get the Care You Need?

Nobody wants to drain their savings paying for long-term care. If you have significant assets, it’s worth looking into legal and financial strategies to protect them while still ensuring you have access to care when needed.

Estate Planning and Trusts

Some individuals use irrevocable trusts to shield assets while qualifying for Medicaid. Others work with estate planners to develop asset protection strategies that comply with Medicaid’s look-back period rules. Consulting a financial advisor can help you make informed decisions about protecting your financial future.

Preparing Now Can Save You Financial Stress Later

Long-term care is a significant financial challenge that many people overlook until it’s too late. Medicare only covers short-term, medically necessary care, leaving a significant gap in coverage for extended nursing home stays, assisted living, and home care. Understanding the limitations of Medicare and exploring alternatives like Medicaid, long-term care insurance, or personal savings can help you prepare for the future without putting your finances—or your family’s—at risk.

If you need help understanding your Medicare options or planning for long-term care, get in touch with a licensed agent listed on this website. They can guide you through your options and help you make informed decisions about your healthcare coverage.