Medicare Does Not Cover Long Term Care After 100 Days Part 3
Understanding the Truth About Medicare and Long-Term Care
Many people mistakenly believe that Medicare covers long-term care — but that’s not the case. Medicare is designed to cover medical expenses for acute conditions, such as a stroke or heart attack. It will pay for hospitalization and treatment during recovery, but once the person no longer requires hospital-level care, Medicare stops paying. At that point, the individual is responsible for covering their own long-term care costs.
When Does Medicare Cover Skilled Nursing Care?
Medicare does provide limited coverage for skilled nursing facility (SNF) care — but only under specific conditions:
- The person must have been admitted to a hospital for at least three full days as an inpatient.
- Admission to the skilled nursing facility must happen within 30 days of leaving the hospital.
- A doctor must certify that skilled nursing care is medically necessary.
Medicare will not pay for custodial or personal care outside a nursing facility unless the person qualifies for skilled nursing or rehabilitation care. If qualified, Medicare will cover both medical care and assistance with daily living activities — but only for a limited time.
Limits on Skilled Nursing Facility Coverage
Even if all qualifications are met, Medicare’s SNF coverage is capped:
- Days 1–20 – Medicare covers 100% of approved costs. This does not mean that you will get the full 20 days unless it’s deemed medically necessary.
- Days 21–100 – The patient pays a daily co-payment ($211 in 2025); Medicare covers the rest. Again, you will not be able to stay the full 100 days unless it’s deemed medically necessary.
- Day 101 and beyond – Medicare pays nothing.
The day that a patient is admitted to the hospital or skilled nursing facility, they are working on their discharge game plan.
Plans like Medicare Advantage or Medigap may help cover the co-payment but once Medicare stops paying, the additional coverage ends as well. After 100 days, patients must rely on personal savings, long-term care insurance (if they have it), or Medicaid to cover costs.
Medicare and Home Health Care
Medicare does cover some home health care services, but only under strict conditions:
- A doctor must order the care and certify that it’s medically necessary.
- The care must involve skilled nursing or therapy — not just personal care.
- The services must be provided by a Medicare-certified home health agency.
- The patient must be considered homebound — meaning leaving home requires a significant effort and happens infrequently.
If the patient qualifies, Medicare may also cover medical social services, home health aide services, medical supplies, and durable medical equipment used at home. However, Medicare does not cover custodial care at home, such as help with bathing, dressing, or meal preparation.
Medicaid: The Safety Net for Long-Term Care
When Medicare and private insurance fall short, Medicaid becomes the fallback for long-term care — but only for those who meet strict financial and functional eligibility requirements. To qualify, individuals must have limited income and assets, often needing to "spend down" their resources before becoming eligible.
Medicaid covers:
- Nursing home care
- Long-term care services at home and in the community
Medicaid has become the largest public payer of long-term care in the U.S., covering about one in two nursing home dollars. In 2022, Medicaid spent approximately $154 billion on long-term care, making up nearly 20% of its total budget.
How Medicaid Emerges as a Primary LTC Payor
Medicare offers only short-term solutions for skilled nursing and home health care — not ongoing long-term care. For extended care needs, Medicaid or private long-term care insurance may be the only options. Many elderly people who find themselves needing long-term care and who do not have LTC insurance begin paying for their services themselves when they learn Medicare will not be coming to their rescue. Unfortunately, most quickly discover that their financial resources are not sufficient to cover home health care services or lengthy stays in nursing home facilities for an extended period.
So, for those without insurance coverage and without significant financial or family care resources, the only recourse to long-term care is Medicaid. More details to come in the next article!
Having a plan in place can make all the difference
Taking a good look at your income and assets; and understanding the limits on what Medicare will pay for is crucial for planning ahead and avoiding financial surprises. After all, aging is inevitable. But facing it unprepared doesn’t have to be.