“Doesn’t Medicare Pay for Long-term Care?”

“Doesn’t Medicare Pay for Long-term Care?”

Senior looking through binocularsMany seniors believe Medicare will take care of everything. It is an unfortunate perception that is inaccurate. Two days ago, I was presenting senior living options to a group of seniors. One senior raised their hand and asked how Medicare fit in the picture of paying for senior housing.

Here was my answer, “You have worked hard your whole life to have Medicare insurance. Most seniors have Medicare, a HMO and supplemental insurance. These will help you pay for doctors, hospital stays and up to 100 days of skilled nursing care (if you have a qualifying hospital stay).  Medicare will not pay for any long-term care such as support in an assisted living community, long-term skilled nursing care or memory care.  (I know this was a short version of a long answer.)

Many seniors were surprised…here is some info from Medicare:

“At least 70 percent of people over 65 will need long-term care services and support at some point. ‘Medicare and most health insurance plans, including Medicare Supplement Insurance (Medigap) policies, don’t pay for this type of care, sometimes called ‘custodial care.’ Long-term care can be provided at home, in the community, in an assisted living facility, or in a nursing home. It’s important to start planning for long-term care now to maintain your independence and to make sure you get the care you may need, in the setting you want, in the future.”  This is a quote from the official Medicare and You 2014 Handbook, page 63.

Have you encountered this misperception that Medicare will pay for long-term care?

Diane Twohy Masson’s new guide book for seniors, “Your Senior Housing Options,”  is available on Amazon.com with a 5-star rating.  It reveals a proactive approach to navigating the complex maze of senior housing options. It will help you understand the costs and consequences of planning ahead or waiting too long.  Learn firsthand tips from someone who is currently advocating for three aging parents.

Among the thousands of seniors she and her teams have assisted in finding the right senior living community, the most difficult case has been helping her own parent. Masson spent two years exploring senior housing options with her mother before finding the ideal Continuing Care Retirement Community for her. After eight years in this independent living setting, she helped her mother transition into an assisted living community. Seven years later, even as a senior housing expert, Masson struggled with the decision to move her mother into a skilled nursing community.

More related articles by Diane can be found at  Tips2Seniors.com or like Tips 2 Seniors on Facebook.

Diane Twohy Masson has worked in senior housing since 1999. She is an award-winning certified aging services professional and the author of Senior Housing Marketing: How to Increase Your Occupancy and Stay Full for senior living professionals.


  1. Diane,

    Great article! The latest info I can gather about long-term care shows that people will need at least $1,000,000 in the bank, if any remain, to take care of long-term issues.

    It is about to get really ugly for the baby boomers!


    • Yes, you are right. It is so expensive. With two in-laws needing long-term care, they will run out of assets in about five years.

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  3. Yes, it’s amazing how many seniors are not aware that Medicare and Medicaid pay do not pay for long-term care services unless destitute. Agree with you Craig, the “silver tsunami” is rapidly approaching for those 78 million baby boomers. They are in for a big surprise if they haven’t taken care of there long term care future.

  4. From Linked IN
    Carole S Fiedler
    Expert Life Settlement & Viatical Settlement specialist, consultant, broker at Innovative Settlements(r) since1992
    If only more people understood how important it is to have gotten LTCi when they are still young and healthy enough to get it! Many people who come to me to liquidate their life insurance policies are using the money for their immediate as well as long term care needs. That’s one of the beauties of Life Settlements – an illiquid asset, the life insurance policy, can be liquidated later in life, with the money going to whatever need the insured desires. Being “too sick” to qualify for a Long Term Care policy may just be “sick enough” to qualify for a life settlement.

  5. Debbie Serriano
    Medicaid Coordinator at Pathways Nursing and Rehabilitation Center
    I answer these questions about medicare everyday once they have plateau with their baseline, or become custodial or a permanent placement. They need to seek another payor source. Even with Ltc policies people are surprised at what they paid for it and what services they are entitled to under their plan.

  6. From Linked In
    Thomas Sobczak, Jr.
    Advisor | Information Technology | Operations | Healthcare | Telemedicine | mHealth
    Medicare only pays for 30-90 days of home care after one has been in the hospital, nursing home or rehab for more than 3 days. It’s a real shock to seniors to learn that Medicare won’t cover their care at home.

  7. From Linked IN
    Cindy Janssen
    Cindy Janssen
    Principal and Owner at Senior Savvy Marketing Solutions


    Great topic, and one that has prevalent for at least twenty years. Medicare needs to be very clear in it’s communications —bullet point clear—so that this surprise for seniors does not come at a bad time. Yes, we need to hold more seminars to educate our older population as to what is covered and what is not. It is still amazing to me that prospects and their children think Medicare will even cover a part of housing, not to mention all of the SNF and ALF fees. This is a great open house topic. Thanks for bringing it to the forefront.

  8. From Linked IN
    Lorie Eber
    Personal Wellness Coach at Lorie Eber Wellness Coaching
    Top Contributor

    Most people of all ages mistakenly believe that Medicare covers assisted living. They are often shocked when they find out that it is all private pay. This is an issue that education is definitely needed on!

    • From Linked IN
      Kent Mulkey
      Keystone Senior Management Services

      But, it isn’t all private pay, at least not in the many states that accept federal dollars for assisted living (Medicaid). 44 states provide some kind of funding for assisted living.

      • Diane Masson
        Regional Marketing Director at Freedom Management Co.

        Hi Kent! Your key words were some kind of funding. If there is assisted living funding in a state, the senior or their family has to find the assisted living community that offers Medicaid. In Washington state they were very sad and very full. The biggest challenge is they were hard to find and short staffed. Where did you get your statistics on 44 states? I didn’t think it was that high. Do you or anyone know of a good quality Medicaid assisted living community in any state?

  9. From Linked IN
    Steve Wittman
    Director of Operations at Link-age

    Diane makes a great point with her comments. There are many misconceptions in the marketplace concerning Medicare and Medicaid. As Diane pointed out, there are a number of qualifiers for the limited coverage that Medicare provides. A three day qualifying hospital stay and a need for “skilled services” are two big ones. Even though beneficiaries qualify for 100 days of skilled care per year, they must meet the initial qualifications and they must be making progress towards and established goal to continue that coverage, Finally, there is a patient co-pay after the first 20 days if coverage extends that long.

    From a Medicaid perspective, many seniors do not understand the spend down requirements that must be met to qualify for this program.

    Education is critical in this space. As they plan for their retirement, seniors should have an understand of the coverage provided by these programs. Once they retire, having a working knowledge of these programs allows them to make more informed choices as to their living arrangements and options for care.

  10. Linked IN
    Michael Tartaglia
    Executive Director
    yes, many people think Medicare is a major payor when they are only willing to pay for skilled services up to 100 days. With the advent of Managed Medicare they keep cutting the benefit further. Medicaid is the major payor but for most elderly they have to deplete their resources to obtain it.

    • Yes, the names are so similar. When I got in senior housing it was confusing to understand the differences between Medicare and Medicaid.

  11. Thanks, Diane. A good reminder for me as I try to re-focus (slightly) from VA & Medicaid planning to helping seniors truly plan ahead. And,”Amen” to Craig’s thoughts. We ain’t seen nuttin’ yet.

  12. Invariably, the majority of Seniors attending our educational seminars believe that Medicare will pay for hospital and skilled nursing expenses. We show them how to plan to pay for care if needed without depleting assets, purchasing long term care insurance or resorting to a reverse mortgage AND the important of having updated legal documents to help prevent problems arising from a hospital stay. Virtually none are aware of the OBSERVATION STATUS hospitals are now using that virtually guarantees Medicare will not cover a stay -even if it is for 3 nights.

    • It is very difficult for someone who is ill or injured in the hospital to know if they have had a qualifying stay. It’s better to have an advocate who can fight on your behalf, if you no longer have a voice like my mother-in-law. People need to select a Power of Attorney who can work the system on their behalf.

  13. Nice succinct article explaining this. Nice selection of comments. I believe that when kids graduate from high school, they should all be handed a “mandatory” come back between 30-45 for a mandatory “aging classes” so they can learn how to be prepared for: 1) what is going to slam them between the eyes when/if their parents have one of the many predictable aging issues that devastates life and quality of AND, 2) for their OWN life planning. I spoke (as a professional senior living advisor) with over two thousand families – the SMARTEST, the biggest hearted…the richest – STILL so unprepared when these issues hit them like a two by four off of their feet. SO COMMON family care givers worn out, financing scrambled for – another grave misconception is how long term home care can cost MORE than a nice Assisted Living (economies of scale here)…and the shock of “it costs how much??????” THIS SHOULD NOT BE THE CASE – we should have everyone prepared as to the many planning steps (get your power of healthcare attorneys in place – I believe in having alternate), LEARN what happens and what steps you will need to learn about in a crisis…AHEAD of time – JUST like disaster training. Thank you Diane Mason – if you ever get to Nashville TN, I would love to sit down with you.

    • Great idea Carole on teaching kids about aging and how to be prepared for themselves and their parents. I would love to sit down and talk with you if you ever come to Southern CA. Maybe we can meet at a senior housing conference.

  14. Diane,

    Be sure to show this to those parties interested: http://www.usdebtclock.org/

    This is why costs are what they are today, and why we have yet to see the roof be blown off the system. Give it a couple more years!