Key Takeaways

• Medicare’s long-term care coverage remains limited, but recent updates in 2025 improve transitional and caregiver support.

• Understanding when Medicare covers skilled care vs. custodial care can help you better plan for your loved one’s needs and avoid unexpected costs.

Medicare Isn’t Designed to Cover Long-Term Care—But That’s Only Part of the Story

If you’re caring for a loved one, you’ve likely already discovered how complex Medicare can be when it comes to long-term care. Medicare isn’t a long-term care insurance program, but that doesn’t mean it offers no support. In 2025, some important updates are changing the way Medicare supports families, especially during transitions from hospital to home or nursing facility.

Long-term care includes a range of services for people who are unable to perform basic activities of daily living (ADLs) on their own—such as bathing, dressing, or eating. These services can take place at home, in assisted living, or in a skilled nursing facility.

What Medicare Still Doesn’t Cover

Before getting into the changes, it’s critical to understand what hasn’t changed. Medicare does not cover:

• Long-term custodial care in a nursing home

• 24/7 personal care at home for daily living activities

• Most assisted living facility costs

These services are still your responsibility to plan and pay for, either out-of-pocket or through other insurance programs like Medicaid or long-term care insurance.

What’s New in 2025: Transitional Support and Expanded Services

While Medicare still doesn’t pay for long-term custodial care, it has introduced or expanded several provisions that can help you provide better support for your loved one.

1. Extended Transitional Care Coordination

Medicare now emphasizes transitional care for patients moving from a hospital to a skilled nursing facility (SNF) or from an SNF to home. These transitions are a high-risk time for older adults, especially when managing multiple conditions.

In 2025, Medicare is investing in longer coordination periods, extending the window from 30 days to 45 days after hospital discharge. This means your loved one may receive:

• Follow-up visits with a nurse practitioner

• Medication management assistance

• Help coordinating appointments and transportation

2. Greater Focus on In-Home Health Services

Medicare covers intermittent home health services, but the scope in 2025 has expanded for those meeting eligibility requirements. If your loved one is homebound and requires skilled services such as nursing care, physical therapy, or speech-language therapy, these may now include:

• Virtual care check-ins with qualified clinicians

• Enhanced caregiver education and training

• Remote monitoring tools for chronic conditions

3. New Allowances for Caregiver Training and Support

One of the most welcome updates in 2025 is caregiver-specific support. Medicare Advantage plans are now permitted (but not required) to offer supplemental benefits, including:

• In-home caregiver training sessions

• Short-term respite care arrangements

• Access to adult day health programs

While these additions vary by plan, they reflect a broader acknowledgment of the critical role family caregivers play.

When Medicare Covers Skilled Nursing Care

Medicare will cover a short-term stay in a skilled nursing facility, but only under specific conditions. To qualify in 2025, all of the following must apply:

• The patient had a qualifying inpatient hospital stay of at least three consecutive days (not counting the discharge day).

• A doctor certifies the need for daily skilled nursing or therapy.

• The care must be provided in a Medicare-certified facility.

Cost Sharing Breakdown in 2025

• Days 1-20: $0 coinsurance (covered fully by Medicare)

• Days 21-100: $204 per day coinsurance (approximately)

• After day 100: You pay all costs

You should keep track of these timeframes carefully. Many caregivers are caught off-guard when Medicare stops paying on day 101.

Understanding the Limits of Home Health Care

Medicare’s home health care benefit can be a vital support system—but only when the requirements are met. In 2025, Medicare covers home health care if:

• Your loved one is homebound (leaving home requires considerable effort)

• They need intermittent skilled care (e.g., wound care, IV therapy, or rehab)

• Services are provided under a care plan created by a doctor or qualified practitioner

Covered services may include:

• Skilled nursing care

• Physical, occupational, or speech therapy

• Home health aide (part-time, for personal care)

• Medical social services

However, full-time personal care or household services like cleaning, meal preparation, or 24/7 monitoring are not covered.

Hospice Care: When Comfort Becomes the Priority

If your loved one is diagnosed with a terminal illness and has a life expectancy of six months or less, Medicare’s hospice benefit may provide essential support.

Covered services under Medicare hospice include:

• Doctor and nursing services

• Pain relief and symptom management

• Grief counseling and bereavement support for family

• Short-term inpatient respite care

In 2025, hospice services continue to be available both in-home and at approved hospice facilities. Medicare typically pays for all hospice-related care with minimal out-of-pocket costs.

When Medicaid Steps In

When your loved one’s needs go beyond Medicare’s coverage—particularly for long-term custodial care—you may need to explore Medicaid as a secondary option. Medicaid is jointly funded by federal and state governments and is based on income and asset limits.

If eligible, Medicaid can help cover:

• Nursing home care beyond 100 days

• Assisted living in certain states

• Home and Community-Based Services (HCBS)

Some individuals qualify for both Medicare and Medicaid, known as dual-eligible beneficiaries. In these cases, Medicare is the primary payer, and Medicaid can help with costs Medicare doesn’t cover.

Planning Ahead: Why Timing and Documentation Matter

Because Medicare only provides limited long-term care coverage, planning is key. As a caregiver, being proactive with documentation and eligibility criteria can avoid delays or denied claims.

Make sure you:

• Keep a written copy of your loved one’s hospital discharge summary

• Ask the doctor to certify the need for skilled services

• Review the Medicare Summary Notice (MSN) for any changes in coverage

• Save all receipts and written care plans

Also, don’t assume coverage will automatically continue. Each benefit has a review period or re-certification requirement, which may impact payment or services.

Caregiver Burnout Is Real—Medicare May Offer Relief

In 2025, Medicare recognizes the toll that caregiving takes. Beyond medical services, some plans now offer access to mental health providers, telehealth counseling, or support groups for caregivers.

You may be eligible to:

• Schedule virtual therapy sessions for stress or depression

• Receive referrals for local caregiver respite programs

• Use caregiver apps approved by your loved one’s Medicare Advantage plan

Even if you’re not enrolled in a Medicare Advantage plan, knowing what benefits are available can help you request better coordinated care.

How to Make the Most of These Changes

If you’re overwhelmed by choices or aren’t sure what your loved one qualifies for, you’re not alone. The first step is to review their current Medicare coverage (Parts A and B) and determine if a Medicare Advantage plan or supplemental benefits could better support your caregiving responsibilities.

You should also:

• Confirm whether your loved one’s providers are Medicare-certified

• Ask about eligibility for caregiver training or home visits

• Contact Medicare or speak with a licensed agent to clarify benefits

Every plan is different, and benefits can vary based on location and plan design, especially for Medicare Advantage plans.

Supporting Your Loved One Starts with Understanding Medicare

Caring for someone who needs long-term help is never easy. But understanding how Medicare can—and can’t—help gives you the power to plan better. From short-term skilled nursing to in-home health services and hospice care, Medicare’s 2025 updates make it more responsive to the real-life needs of caregivers and families.

Now is a good time to evaluate your loved one’s current health care plan. If you’re unsure whether their Medicare coverage meets their current or future needs, get in touch with a licensed agent listed on this website for guidance specific to your situation.