Long-term care is one of those things we don’t want to think about until it becomes urgent. But planning ahead—especially when Medicare is involved—can make a huge difference for seniors and their families. The key is knowing what types of care Medicare will help pay for, what it won’t, and where to find services that match your needs.
Understanding What Medicare Covers (and What It Doesn’t)
Medicare isn’t designed to be a catch-all for long-term care. It mainly covers medical care, not custodial care (which is what most people associate with long-term support—help with bathing, eating, dressing, and other daily tasks). But there are still ways Medicare can help.
Medicare Part A, which most people get premium-free, will pay for limited stays in skilled nursing facilities (SNFs), hospice, and some home health care—but only if certain conditions are met. For example, you need to have been admitted to a hospital for at least three days before transferring to a SNF, and even then, Medicare only pays fully for the first 20 days. After that, there’s a copayment, and coverage stops entirely after 100 days.
Medicare Part B may cover things like physical therapy, occupational therapy, and certain types of in-home medical care, but again, not for extended help with non-medical tasks. The newer Medicare Advantage (Part C) plans, however, are expanding what they offer. Some include limited coverage for adult day care, meal delivery, transportation, or personal care support—benefits that traditional Medicare doesn’t include.
Where to Start When Looking for Covered Services
Navigating the system can feel overwhelming, especially when you’re juggling health conditions, family opinions, and financial pressure. But there are a few solid places to start. Medicare.gov’s Care Compare tool is one of the best resources for locating nearby skilled nursing facilities, home health agencies, and hospice providers that accept Medicare. You can filter results by distance, ratings, and services offered. For seniors who want to stay at home but need skilled help, this tool also helps find certified in-home care agencies that work with Medicare.
Another great resource is your local State Health Insurance Assistance Program (SHIP). They offer free counseling to help seniors and caregivers understand what options are available, how to apply, and which Medicare Advantage plans might offer better long-term care benefits. Many families overlook this, but SHIP advisors are especially helpful when it comes to identifying hidden benefits or navigating appeals if coverage is denied.
If you’re unsure about what’s medically necessary (and therefore billable under Medicare), ask your doctor. Physicians can refer patients to home health agencies, physical therapy, or hospice services that meet Medicare requirements. Having the right documentation and referrals in place upfront avoids headaches down the line.
Maximize Long-Term Care Options Under Medicare
Use Care Compare: Check the Care Compare tool to compare local facilities and agencies
Ask about Medicare Advantage extras: Some plans include transportation, home care, and caregiver support
Talk to your doctor: Get a referral for medically necessary services to trigger Medicare eligibility
Contact SHIP: Visit https://www.shiphelp.org/ to get local help and advice from unbiased counselors
Understand limitations: Traditional Medicare does not cover assisted living or custodial care
Look into Medicaid crossover: If the senior qualifies, some long-term care costs may be shared
Types of Long-Term Care and Medicare Coverage
| Type of Care | Covered by Traditional Medicare? | Covered by Medicare Advantage? | Notes |
|---|---|---|---|
| Skilled Nursing Facility (short-term) | ✅ Yes (with conditions) | ✅ Yes | Up to 100 days post-hospital stay; first 20 days fully covered |
| Home Health Care | ✅ Yes | ✅ Yes | Must be ordered by a doctor and deemed medically necessary |
| Hospice Care | ✅ Yes | ✅ Yes | For terminal illness with life expectancy under six months |
| Custodial Care (bathing, dressing) | ❌ No | ⚠️ Limited in some plans | Some Advantage plans offer support; traditional Medicare does not |
| Assisted Living Facilities | ❌ No | ❌ No | Not covered by Medicare |
| Adult Day Care | ❌ No | ⚠️ Possibly | Select Medicare Advantage plans may offer limited coverage |
Consider Other Support Programs
If the senior is a veteran, the VA Aid and Attendance benefit can help pay for personal care or assisted living, even if Medicare won’t. And if your family bought a long-term care insurance policy years ago, now might be the time to dust it off and review what it covers.
Don’t overlook community services either. Area Agencies on Aging can help connect seniors to meal delivery, transportation, and caregiver support services—some of which may be free or donation-based.
Know When to Ask for Help
Long-term care planning is emotional and complex. Don’t wait until you’re in crisis to start exploring your options. Start with what Medicare can offer, see what gaps remain, and then build a patchwork of resources that meet your specific needs. Getting professional help—from SHIP counselors, care managers, or elder law attorneys—can save money, time, and stress.
While Medicare won’t pay for everything, it can be a solid foundation. And with more Medicare Advantage plans offering non-medical perks, plus partnerships with community services and Medicaid, it’s possible to piece together a plan that helps seniors age safely, affordably, and with dignity.
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