Medicare & Medicaid · The confusion that costs families the most time

Does Medicare Pay for Long-Term Care?

No, not the ongoing kind. Medicare covers up to 100 days in a skilled nursing facility after a qualifying hospital stay, and home health care when you're homebound and need skilled care — both time-limited and condition-limited. It does not cover an ongoing nursing home stay, assisted living, or indefinite in-home custodial help. Medicaid is the program that actually pays for long-term custodial care, and it has its own income and asset rules — which is where families who assumed "we have Medicare" run into a second, separate eligibility problem, often for the first time, right when a parent needs care.

Last reviewed 2026-08-19.

What Medicare actually covers

Medicare's long-term-care-adjacent coverage is real but narrow, built around skilled, medically necessary care rather than ongoing daily-living help:

Skilled nursing facility (SNF) care — up to 100 days per benefit period, but only after a qualifying inpatient hospital stay of at least 3 consecutive days, and only when skilled care (not just custodial help) is medically necessary. Days 1–20 are covered in full; days 21–100 carry a daily coinsurance; after day 100, Medicare pays nothing. See does Medicare pay for nursing home care for the full breakdown.
Home health care — no deductible or coinsurance, but only when you're homebound and need part-time or intermittent skilled nursing or therapy, ordered by a doctor. See does Medicare pay for home health care for the eligibility details.
Medical care received while living somewhere else — doctor visits, therapy, and covered medical services still apply even if you live in an assisted living community. What Medicare won't pay for is the room, board, and custodial-care fees the facility itself charges. See does Medicare pay for assisted living.

What Medicare doesn't cover

Custodial care — help with bathing, dressing, eating, using the bathroom, and general supervision — isn't covered by Medicare on its own, no matter where it happens, unless it's bundled with the skilled care above and within its limits. That means an ongoing nursing home stay past 100 days, assisted living room and board, and indefinite in-home personal care are all outside what Medicare pays for. This is the single biggest source of the "I thought Medicare covered this" surprise, and it isn't a loophole or a mistake in how the program runs — Medicare was built as health insurance, not custodial-care insurance.

What actually pays for long-term care

Three sources cover most long-term care in practice: private pay (out of pocket), long-term-care insurance (a separate policy, not Medicare), and Medicaid. Medicaid is the one that covers the largest share of long-term nursing home and home-care costs nationally, but it comes with its own eligibility test — income and asset limits that have nothing to do with Medicare eligibility. Someone can be fully covered by Medicare and still not qualify for Medicaid because their monthly income is a few hundred dollars over the state's limit — a specific, common, and solvable problem, not a dead end.

The income-over-the-limit problem has a fix

In more than 24 states, someone whose monthly income exceeds their state's Medicaid long-term-care limit can still qualify using a Qualified Income Trust — commonly called a Miller Trust. It's an irrevocable trust that redirects the excess income so it isn't counted toward the cap. It doesn't touch savings or property, only the monthly income problem — which is exactly the gap that opens up once families discover Medicare's 100 days have run out or were never going to cover the situation to begin with. See the complete Miller Trust guide to check whether your state uses this mechanism.

Frequently asked questions

Does Medicare pay for long-term care?

No — not the ongoing kind most people mean by "long-term care." Medicare is a health-insurance program built around medically necessary, skilled care for a defined period, not indefinite help with daily living. It does pay for specific, limited situations: up to 100 days in a skilled nursing facility after a qualifying hospital stay, and home health care when you're homebound and need skilled (not just custodial) services. It does not pay for an ongoing nursing home stay, assisted living room and board, or in-home custodial help by itself. Medicaid is the program that actually covers long-term custodial care for people who qualify.

Why doesn't Medicare cover long-term care?

Because of how it was designed: Medicare pays for medically necessary treatment aimed at recovery or maintenance of a defined health condition, the same logic that governs hospital and doctor coverage. Long-term custodial care — help bathing, dressing, eating, using the bathroom — isn't medical treatment in that sense, even though it's essential care. Medicaid, a separate program with its own eligibility rules based on income and assets, is the one built to cover it.

What is the difference between Medicare and Medicaid for long-term care?

Medicare is federal health insurance nearly every American 65+ has, regardless of income, and it covers short-term skilled care with real limits (100 days in a nursing facility, homebound-only home health). Medicaid is a joint federal-state program for people who meet income and asset limits, and it's the program that actually pays for ongoing nursing home care and many home-care services long-term. Most people who end up needing nursing home care exhaust Medicare's 100-day limit and then have to qualify for Medicaid — which is where an income that's technically "too high" for Medicaid, despite being nowhere near enough to privately pay for care, becomes the actual problem a tool like a Miller Trust solves.

What if my income is too high for Medicaid but I still need long-term care?

This is a specific, solvable problem in the 24+ states that allow it, and it trips up more families than the income limit itself deserves to. A Qualified Income Trust (also called a Miller Trust) lets someone whose monthly income exceeds their state's Medicaid limit still qualify, by redirecting the excess into an irrevocable trust instead of counting it toward the cap. See our complete Miller Trust guide for how it works and whether your state uses one.

Miller Trust Guide is an informational publisher, not a law firm or an insurance agency — we don't sell Medicare plans and this page is not medical or legal advice. See also nursing home coverage, assisted living coverage, and home health coverage for the full detail on each. See the editorial process and about the author.