Masthead Image

Who Pays For Long-Term Care?

MEDICARE

MEDICARE

Medicare Only pays for Long Term Care if you require skilled services or rehabilitative care: 

In a Nursing Home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days). 

At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time. It does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services

You will have to pay for long-term care services that are not covered by a public or private insurance program

MEDICAID

MEDICAID

Medicaid is a joint federal and state government program that helps people with low income and assets pay for some or all of their health care bills. It covers medical care, like doctor visits and hospital costs, long-term care services in nursing homes, and long-term care services provided at home, such as visiting nurses and assistance with personal care.

Unlike Medicare, Medicaid does pay for custodial care in nursing homes and at home. Overall program rules for who can be eligible for Medicaid and what services are covered are based on federal requirements, but states have considerable leeway in how they operate their programs. States are required to cover certain groups of individuals, but have the option to cover additional groups. Similarly, states are required to cover certain services, but have the option of covering additional services if they wish to do so. As a result, eligibility rules and services that are covered vary from state to state.

To be eligible for Medicaid you must meet certain requirements, including having income and assets that do not exceed the levels used by your state. 

Once your state determines that you are eligible for Medicaid, the state will make an additional determination of whether you qualify for long-term care services. When determining whether you qualify for long-term care services, most states use a specific number of personal care and other service needs to qualify for nursing home care or home and community-based services. There may be different eligibility requirements for different types of home and community-based services.