FYI: To learn more about Medicare and hospice coverage, read our guide: Does Medicare Cover Hospice?
Long-term care, also known as custodial care, is generally not covered by Medicare. Because this type of care primarily involves assisting with activities of daily living (dressing, bathing, eating, etc.), it’s considered personal care, rather than medical care, and is thus not covered by Original Medicare.
Long-term care consists of any services dedicated to assisting a person with their activities of daily living. Any care involving these activities, such as bathing, dressing, or using the restroom — including most services offered in assisted living and nursing homes — falls into this category.
Original Medicare has two parts: A and B.
Part A (hospital insurance) covers services like inpatient care at a hospital, hospice care, and some home health care. It also covers inpatient care at skilled nursing facilities, which, compared to nursing homes, are short-term as opposed to long-term.
Part B (medical insurance) covers medically necessary and preventative services, such as ambulance rides, diagnoses, and durable medical equipment. It also won't cover long-term care.
Original Medicare will cover some long-term care services, including skilled nursing facility stays and various home care options.
With Medicare, you can expect to pay the following for skilled nursing care in 2023:
A Skilled nursing facility (SNF) is able to provide professional staff to monitor, manage, or treat medical/health conditions. SNF professionals include registered nurses, occupational therapists, technicians, speech therapists, and audiologists. Patients who may need care provided at an SNF include those recovering from an acute health condition, injuries requiring physical or occupational therapy, and care that requires the use of intravenous medications.
Any health care services received in your home, rather than going to a hospital or doctor’s office, qualify as home health care. In 2023 Medicare Parts A and B will cover the following services at home:
It’s important to note, however, the difference between home health care and home care. Home health care is medical by nature and is thus eligible for Medicare coverage. Home care, however, is deemed custodial and not usually eligible for Medicare coverage.
Home care services not covered by Medicare include:
Medicare Part A will cover most of the costs associated with hospice, provided a person meets the following conditions:
With Original Medicare, you’ll pay nothing for hospice care; however, the following costs may still remain:
FYI: To learn more about Medicare and hospice coverage, read our guide: Does Medicare Cover Hospice?
Original Medicare does not pay for most long-term care needs, such as activities of daily living. Medicare only covers short-term stays at SNFs, in-home care, and hospice care. Luckily there are other options to assist patients seeking long-term or custodial care.
Anyone with Original Medicare can apply for a Medicare Advantage plan. These plans include Medicare coverage alongside other special benefits, depending on the plan. Some Advantage plans offer extra benefits, including daily services for chronically ill patients. But terms for Medicare Advantage plans often shift annually, the insurance does not travel with you, and premiums for copays can be very high. Make sure you research Medicare Advantage plans carefully before choosing one.
Medigap is supplemental insurance coverage provided by private companies in order to fill the “gaps” in your Original Medicare coverage. This can include extending temporary stays at SNFs and reducing out-of-pocket costs not covered by Part A. Since there are 10 Medigap plans, and not every insurer carries every plan, be sure to research Medigap options carefully.
Pro Tip: To learn more about Medigap, read our rundown of this year’s best Medigap providers.
Some providers or companies sell this type of insurance dedicated to covering long-term care, including custodial care. These policies are separate from your Medicare coverage and must be purchased from private insurers. To get started, be sure to check out our guide to this year’s best long-term care insurance.
PACE stands for Program of All-Inclusive Care for the Elderly, and refers to programs set up in some states to assist elderly people with long-term and in-home health and medical care costs. Programs vary by state, so research the PACE website for more information.
Your local Veterans Affairs center may offer programs dedicated to assisting with long-term medical costs. Visit your local VA to find complete information.
Unfortunately, Medicare doesn't cover most long-term and custodial care dedicated to assisting daily activities. When seeking long-term care and assistance, it is essential to research all options and plan carefully in advance for specific care. Understanding all your options can lead to less stress and red tape in the future, and allow you to focus on comfort.