What do seniors often misunderstand about Medicare's coverage for long-term care?

Question

Joseph Bachmeier · Accepted Answer

Some seniors think that Original Medicare covers all aspects of post hospital care. That is not the case. Original Medicare only covers "Skilled Nursing Care" and only for a certain period of time. Occupational and speech therapy is post-hospital care most people need but is only covered under Long-Term and Short-Term care plans.

Answered by Joseph Bachmeier on March 25, 2025

Agent Licensed in PA, AZ, DE & 5 other states

Answered by Joseph Bachmeier Medicare Insurance Agent

Tony Capraro III · Answer

They believe that Medicare covers LONG term Care and it does not ! That is why it's so imprtant to work with someone who knows ALL the specifics about Medicare and all  the other options!

Tasha Riggs · Answer

They believe Medicare Covers Long term care. It does not. After 90 Days in a Skilled Nursing or Hospital and you are not getting better you will need extra assistance above what your health plan will cover.

Answered by Tasha Riggs on March 27, 2025

Broker Licensed in CO, AZ, HI & 10 other states

Answered by Tasha Riggs Medicare Insurance Agent

Mark Maliwauki · Answer

This is a very good explanation from the source of truth ie; Medicare.gov on what Medicare's role is in covering long term care.

https://www.medicare.gov/coverage/long-term-care

Paul Potter · Answer

The purpose of Medicare is to health insurance coverage.  That does include hospitalizations, which usually do not last long, and skilled nursing, which we usually think of as rehabilitation services.  These visits, also do not usually last long.

The purpose of Long Term Care is to help people maintain their quality of life and well-being, typically when they are unable to independently perform daily activities.

Long Term Care Insurance is the tool that is used to help manage costs for Long Term Care.  This insurance is private insurance and requires an application and approval for coverage.

Don Hudson · Answer

Medicare focuses on Short term care in a hospital or rehabilitation services. Medicare is focused on healthcare. If you plan on going into a LTC facility or are concerned that some years down the road you may need to go into a LTC facility, it's best to look into other options that can assist you with LTC benefits. Many Life Insurance and Annuity products have LTC riders that can provide you with benefits.

Answered by Don Hudson on April 1, 2025

Broker Licensed in FL

Answered by Don Hudson Medicare Insurance Agent

Justin Sonon · Answer

Seniors often don't realize that long-term care coverage is not typically covered by Medicare plans.

Brady Kidwell · Answer

Seniors often misunderstand Medicare's coverage for long-term care, believing it covers extensive services like assistance with daily living activities (dressing, bathing, etc.) or long-term nursing home care. In reality, Medicare primarily covers medically necessary care and doesn't typically cover long-term care needs that are primarily custodial or non-medical.

Answered by Brady Kidwell on June 4, 2025

Broker Licensed in TN, FL, GA & KY, NC, SC & VA

Answered by Brady Kidwell Medicare Insurance Agent

Eli Roque · Answer

Medicare benefits only cover Part A Hospital and Part B Medical which means no coverage for long term care . Included in no coverage is prescriptions drugs.

Luke Rhoads · Answer

Medicare generally does cover skilled nursing and home care while it does not provide coverage for assisted living and extended stays in nursing homes.

Steven Bleicher · Answer

Please bear in mind that Medicare rules dictate that only the first 100 days are covered by Medicare when you are placed in a nursing home or an assisted living facility! Then, a previously-bought private LTC policy will kick in! Here is the dilemma: THE most frustrating aspect of LTC, other than its high cost, is when a couple apply for LTC and one is denied coverage while the other is approved. In these cases, the healthy spouse is so upset over this news that he/she decides NOT to pick it up at all! The ramifications of this is for example, the caregiver of the unhealthy partner who may have turned down this LTC policy opportunity now may find that he/she has also been diagnosed with a major condition of their own! Thus, unfortunately now they are BOTH in trouble! Buy LTC insurance as young as you can. The ages of the candidates have everything to do with the pricing per month quotation.

Answered by Steven Bleicher on June 15, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Diana Garner · Answer

Medicare primarily covers skilled medical care, but not the daily living activities such as bathing, dressing, or using the bathroom, which are usually where help is needed in long-term care settings. 

This often leads to financial strain and unexpected expenses when needing long-term care services.

Michael Kim · Answer

They think it's a senior living center. No it's a long term care meaning after you had surgery you are going into a long term care to get healed and get better. You will come out eventually, you will not live there indefinitely.

Answered by Michael Kim on March 25, 2025

Agent Licensed in NV, AR, AZ & 18 other states

Answered by Michael Kim Medicare Insurance Agent

Fred Manas · Answer

Seniors often misunderstand that Medicare covers most, if not all, of their long-term care needs. In reality, Medicare's coverage for long-term care is limited and primarily focused on skilled nursing facility care following a qualifying hospital stay. It doesn't cover the type of ongoing personal care (like bathing, dressing, and eating assistance) that many seniors need. 
Here's a more detailed breakdown of the misunderstandings:
"Medicare will cover all my long-term care needs."
.
This is a common misconception. Medicare primarily covers medically necessary skilled nursing care for a limited period (up to 100 days) following a qualifying hospital stay. It doesn't cover custodial care, assisted living, or adult day programs. 
"Medicare will pay for my nursing home stay indefinitely." Medicare's coverage for skilled nursing facilities is limited to 100 days, even after a qualifying hospital stay. After that, individuals are responsible for the costs, and Medicaid may be an option depending on their financial situation. 
"Medicare will cover home health services for my ongoing care." While Medicare can cover home health services for a limited period under specific circumstances, it does not cover ongoing, non-medical assistance with daily living activities. 
"Medicare will cover assisted living or adult day care." Medicare generally does not cover these types of long-term care settings. 
"Medicare will cover all my medical expenses for long-term care." .
While Medicare covers medical services, it doesn't cover the costs associated with the ongoing non-medical care and assistance that many seniors need.

Gary Henderson · Answer

There is no long-term care provision 

Long-Term care policies are purchased separately. The older you are the more expensive they are

Eizel Mere · Answer

Seniors tend to believe Long Term Care is covered by Medicare, but it is not. They will cover for up to 150 days in the hospital and up to 100 days of skilled nursing care.

Wild Bill Anderson · Answer

This confuses many before we explain it.
Medicare does not cover long term care.  But it can help with rehab at skilled nursing (SNC) as long as they think you could get better. Max benefit under any plan is 100 days. Some would be less.

There are prerequisites under Medicare alone or Supplements in order to get help with rehab at SNC. To get help you need to have atleast 3 days as an inpatient before going to an approved SNC facility.  Observation does not count toward the 3 days. 

Under Advantage plans you usually have no 3 day requirement in the hospital to get help at SNC.

Robert Rowe · Answer

They typically think Medicare covers long term care which in fact it does But for only 21 days fully and 22-90 with very large copays. Long term care is the single largest gap in a Medicare plan.

Jason Kirschner · Answer

They believe that Medicare covers LONG term Care and it does not ! That is why it's so imprtant to work with someone who knows ALL the specifics about Medicare and all the other options!

Jennifer Dixon · Answer

Most insurance carriers including Medicare do not cover Long Term care.   There are separate policies that can be purchased.

Roseann Vandevender · Answer

A number of Medicare recipients believe that Long Term Care is a covered by Medicare and/or their Supplement plans. Custodial Care is not covered by Medicare. Private insurance or Medicaid can be used to cover this expense depending on your financial situation .

Answered by Roseann Vandevender on May 8, 2025

Agent Licensed in OH, AZ, CO & TX

Answered by Roseann Vandevender Medicare Insurance Agent

Eric Stokley · Answer

A common misconception is that Medicare covers all senior living cost. 

It does not pay for room, board, or personal care in senior living communities such as assisted living or independent living.

What do seniors often misunderstand about Medicare's coverage for long-term care?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents Hub
A non-government resource website

What do seniors often misunderstand about Medicare's coverage for long-term care?

Agents: Share Your Expertise

Seniors: Ask a Question of Your Own

Related Questions

Agent Locator

Medicare Agents HubA non-government resource website

Medicare Agents Hub
A non-government resource website