Does Medicare Cover Long-Term Care in 2023?

What Is Long-Term Care?

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.

Medicare Coverage of Long-Term Care

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.

Long-Term Care Services Covered by Medicare

Original Medicare will cover some long-term care services, including skilled nursing facility stays and a variety of home care options.

Skilled Nursing Facilities

With Medicare, you can expect to pay the following for skilled nursing care in 2023:

• Days 1-20: Nothing
• Days 21-100: Daily coinsurance payments (up to $200 in 2023)
• After 100 Days: All costs

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.

Home Health Care

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:

• Part-time skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology
• Medical social services
• Part-time or intermittent home health aide care (only if you’re also getting other skilled services like nursing and/or therapy at the same time)
• Injectable osteoporosis drugs for women
• Durable medical equipment
• Medical supplies for use 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:

• 24-hour-a-day care at your home
• Meal delivery services
• Homemaker services (like shopping, cleaning, and laundry)
• Assistance with activities of daily living (when these are unrelated to your medical care)

Hospice Care

Medicare Part A will cover most of the costs associated with hospice, provided a person meets the following conditions:

• Their doctor certifies that they're terminally ill, with six or fewer months left to live.
• They accept palliative care as opposed to care that attempts to cure a condition.
• They sign a statement choosing hospice care over other Medicare-approved treatments.

With Original Medicare, you’ll pay nothing for hospice care; however, the following costs may still remain:

• Copayments for prescription drugs
• 5 percent of the Medicare-approved amount for inpatient respite care
• Room and board if hospice is administered in a facility

Alternative Ways to Pay for Long-Term Care

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.

Medicare Advantage

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

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.

Long-Term Care Insurance

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 Programs

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.

VA Coverage

Your local Veterans Affairs center may offer programs dedicated to assisting with long-term medical costs. Visit your local VA to find complete information.