As people age or face chronic health conditions, long-term care services such as nursing homes or assisted living facilities can become necessary. Understanding how these services are paid for—especially through Medicaid and Medicare—is essential for individuals and families planning for long-term care.
Medicare and Long-Term Care: Limited Coverage
Medicare, the federal health insurance program for individuals 65 and older or those with certain disabilities, offers limited coverage for long-term care.
What Medicare Covers:
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Short-term skilled nursing facility (SNF) care after a qualifying hospital stay of at least 3 days.
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Up to 100 days of SNF care per benefit period:
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Days 1–20: Fully covered.
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Days 21–100: You pay a daily copayment (e.g., $204/day in 2024).
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After day 100: You pay all costs.
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What Medicare Doesn’t Cover:
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Custodial care (help with activities of daily living like bathing, dressing, eating) when it is the only care you need.
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Long-term stays in a nursing home or assisted living facility.
In short, Medicare is not a reliable source for funding long-term nursing home or assisted living care.
Medicaid and Long-Term Care: The Primary Payer
Medicaid is the primary government program that pays for long-term care, including nursing homes and, in some cases, assisted living.
Medicaid Coverage for Nursing Homes:
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All 50 states require Medicaid to cover long-term care in certified nursing facilities for eligible individuals.
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Must meet financial and medical eligibility requirements:
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Income limits vary by state.
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Asset limits are typically low (e.g., $2,000 for an individual).
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Must be assessed as needing a nursing home level of care.
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Medicaid Coverage for Assisted Living:
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Coverage varies by state and often falls under Medicaid waiver programs (such as Home and Community-Based Services or HCBS).
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Waivers may cover:
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Personal care services
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Medication management
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Case management
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Room and board are often not covered, but care services typically are.
States that provide Medicaid coverage for assisted living through waivers may limit the number of participants, and waitlists are common.
Types of Medicaid Programs That Cover Long-Term Care
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Institutional Medicaid (Nursing Home Medicaid)
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Covers full-time care in a Medicaid-certified nursing home.
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Applicant must meet functional eligibility (nursing facility level of care).
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HCBS Waivers (Home and Community-Based Services)
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Aimed at keeping individuals in the community (e.g., assisted living or at home).
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Services may include personal care, adult day care, and homemaker services.
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Not an entitlement—limited slots and waiting lists may apply.
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Managed Long-Term Services and Supports (MLTSS)
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In some states, Medicaid long-term care is delivered through managed care organizations (MCOs).
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May cover both nursing home and community-based services, depending on the plan.
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Dual Eligibility: Medicare + Medicaid
Some individuals qualify for both Medicare and Medicaid, known as dual-eligibles. In such cases:
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Medicare pays for hospital care, doctor visits, and short-term skilled care.
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Medicaid covers long-term care, nursing home stays, and some assisted living services.
Planning Ahead
Because Medicaid has strict income and asset limits, long-term care planning is crucial. Strategies include:
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Spending down assets appropriately
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Establishing Medicaid-compliant trusts
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Consulting with an elder law attorney
Conclusion
If you’re looking for government support to pay for a long-term care nursing home, Medicaid is the program that provides ongoing coverage, while Medicare only helps temporarily and in limited situations. Assisted living may be covered by Medicaid in certain states through waiver programs, but benefits and availability vary. Understanding your state’s rules and preparing early can make a significant difference in your long-term care options.