How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?

Question

Steven Bleicher · Accepted Answer

Since the doctor whose specialty is treating your malady, she/he will write up “a plan of care” which Medicare accepts. Then based on your progress, that same doctor can increase the number of days of treatment and therapy or release you to your home. The out-of-pocket cost is impossible to determine since you may have a Medigap or an advantage plan with differing benefits. Always rely on the social worker working at your facility who should know the differences between those 2 options chosen when you became Medicare-eligible.

Answered by Steven Bleicher on May 4, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Larry Dalton · Answer

A difficult decision is involved here, where Medicare generally does not cover long-term custodial care. However, if you're fortunate enough to have a long-term care insurance plan, it would play a major role in covering these expenses. Your Medicare may cover some medically necessary Hospice care in these facilities, and another alternative is to explore your state for potential state and federal programs that could help cover your costs.

Answered by Larry Dalton on May 5, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

Ben Washington · Answer

How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility by securing a long term care (LTC) or short term home healthcare plan.

James Carlson · Answer

You will continue to need your Medicare policy and will have to pay the premium.  If you own a 
Advantage plan, the premium can be deducted from Social Security.  If you have a Medicare Supplement plan, you will have to continue to pay out of pocket.  One idea would be to set aside a fixed amount of money invested for income, and use the income and principal if needed to keep the policy in force.

Michael Caldwell · Answer

Medicare generally doesn't cover long-term custodial care in nursing homes or assisted living facilities. If you anticipate needing such care, you'll need to explore other funding options. Your best bet is to talk to a profressional who can walk you through your options.

Answered by Michael Caldwell on May 20, 2025

Broker Licensed in IN, AL, AR & 31 other states

Answered by Michael Caldwell Medicare Insurance Agent

David Quintal · Answer

Simply put, Medicare does not cover costs related to long-term custodial care or assisted living facility. There are options that one can do to prepare for these costs. Options like Medicaid, long term care insurance, or private funding are ways to cover these potential costs. Always speak to a local Medicare broker to assist you with these options.

Answered by David Quintal on May 4, 2025

Broker Licensed in NH, AL, AZ & 14 other states

Answered by David Quintal Medicare Insurance Agent

Jim Willis · Answer

Generally speaking, Medicare does not cover long-term care or custodial cost.

Long-term care insurance is quite pricey if you are in your 50s or older. Talk to a Medicare agent that is also licensed to handle annuities. The agent can help you utilize your 401(k) to roll it tax free into something like an immediate annuity that would handle the payments For long-term care without losing your money.

Angie Templin · Answer

Because Medicare does not cover Medicare, you may want to consider a Long Term Care insurance policy. Another option is to work with a financial planner or attorney that specializes in Medicaid spend down to plan for long term care needs.

Answered by Angie Templin on May 5, 2025

Broker Licensed in TX

Answered by Angie Templin Medicare Insurance Agent

Fred Manas · Answer

Medicare doesn't cover the costs of long-term custodial care in nursing homes or assisted living facilities. To plan for these costs, you'll need to consider options like LTC insurance, savings & potentially qualifying for Medicaid. 
Here are options on how to plan for these costs:
Long-Term Care Insurance:
This type of insurance can help cover the costs of custodial care in a nursing home or assisted living facility, or for in-home care. You'll typically need to qualify for a payout, often requiring assistance with at least two activities of daily living or evidence of cognitive impairment. 
Private Pay:
Many individuals and families pay for long-term care out of pocket, using savings, investments, or even selling assets like property. Be aware that using up these resources may eventually make Medicaid an option. 
Medicaid:
This program, funded by the federal government but administered by individual states, provides coverage for long-term care, including nursing home care, for people with low incomes & limited assets. Eligibility requirements vary by state but typically involve strict income & asset limits. 
Savings & Investments:
Building a dedicated fund for LTC expenses through consistent saving & strategic investing can help offset future costs. 
Health Savings Accounts (HSAs):
If you have a high-deductible health insurance plan, funding a HSA can be a way to save for long-term care expenses & potentially minimize the tax bite. 
Consider Alternate LTC Options:.
The National Council on Aging (NCOA) suggests exploring options like community-based care services, subsidized senior housing, & Continuing Care Retirement Communities (CCRCs). 
Important Considerations:
Medicare Supplement: While Med Supp plans (Medigap) can help cover some costs associated with Original Medicare they don't cover LTC or care lasting more than 100 days. 
Medicare Advantage: Medicare Advantage plans may help cover some LTC costs but coverage costs can vary significantly between plans.

Ross Landon · Answer

You want to apply as early as possible to try to qualify for long-term care policies. They are carefully underwritten so you have to be in reasonably good health in order to buy long-term care policies!

They are quite easy to calculate the cost for because you really only need about three pieces of information to fill out an application and get a quote on what those will cost. About all you need to know is the amount of money needed per month, and the period of time that you want the Benefits to run, and finally What waiting period to use before your benefits begin after you qualify to start receiving benefits. Typically.those would be 60 or 90 days and it acts like a deductible!

Charles Borg · Answer

Long term custodial care isn’t covered by Medicare. To cover long term custodial care, you should have a private insurance policy. Assisted living is a different story. It could be covered by Medicaid if you qualify.

Answered by Charles Borg on June 3, 2025

Agent Licensed in FL & NY

Answered by Charles Borg Medicare Insurance Agent

Douglas Carney · Answer

To help you plan for Medicare costs while preparing for potential long-term custodial care in a nursing home or assisted living. There are smart steps to take for a secure future. Medicare doesn’t cover long-term custodial care, but you can plan by exploring Medicaid, which often covers these costs for low-income individuals—check eligibility at Medicaid.gov and consider spending down assets strategically. Private long-term care insurance, purchased early, can also offset expenses, with policies tailored to your needs. Budget for Medicare Parts A, B, and D premiums and deductibles ($185/month, $257, and up to $590 in 2025, respectively), and consider a Medigap plan to cap out-of-pocket costs.

Answered by Douglas Carney on May 10, 2025

Broker Licensed in FL, GA, NC, OK & TX

Answered by Douglas Carney Medicare Insurance Agent

Fran Lovelace · Answer

Long term custodial care is not provided by Medicare.  That would be through a Long Term Care policy or some sort of savings plan on your part.

Michael Hixson · Answer

Original Medicare does not cover Long-Term Care, Dental, Vision or Hearing. For Long-Term Care you have 3 options for coverage, Long-Term Care Policy, Life Insurance Policy with a Long-Term Care Rider or an Annuity with a Long-Term Care Rider.

Answered by Michael Hixson on May 7, 2025

Broker Licensed in OK, AR & TX

Answered by Michael Hixson Medicare Insurance Agent

Craig Bodner · Answer

Question From a Senior: How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?

That's an excellent question!  It sounds like you already know that Medicare does not cover most long-term care needs, such as nursing home or assisted living costs.  Unfortunately, many people are not aware that they need to plan for it. 

It's critical to understand what Medicare does and doesn't cover.  Medicare Part A may cover short-term care such as skilled nursing when recovering from surgery or injury but it will not cover long-term care day to day assistance such as help with bathing, dressing, etc.  Alternative/Supplemental coverage such as Medicare Advantage or Medigap/Supplemental plans also do not provide that type of coverage (some very limited services are provided with certain Medicare Advantage plans but not long-term).  

However there are some options available for Long-Term Care Coverage:
	• Some Long-Term Care policies provide comprehensive coverage including the costs of nursing homes and assisted living.  But these plans are usually available and affordable before age 65 and while in good health.  It's also important to know that you can be turned downed down for these plans based on medical history.
	• Certain Life Insurance Policies offer long-term care benefits at additional cost.
	• Medicaid (in Arizona it is known as AHCCCS) does cover those expenses but it's critical to discuss the possibility of losing assets (such as ownership of your home).
	• You could use savings alternatives such as Health Savings Accounts if they are available to you (usually from an employer).  But the cost of long-term care can be anywhere from $4,000 - $12,000/month so saving enough to effectively cover expenses usually has to start at an early age.

China Conley · Answer

You can look into long term care insurance. It will help cover your expenses if you will need it in the future.

Jake Dalton · Answer

Medicare does not cover custodial care in a Nursing Home. You would need to purchase a LTC policy while healthy. There are options with Annuities, Life/LTC hybrids, and traditional LTC policies.

How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?

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How can I plan for Medicare costs if I expect to need long-term custodial care in a nursing home or assisted living facility?

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