Medicare and long-term care: what's not covered and other options

Long-term care means help with everyday activities, like bathing, dressing, eating or getting around, over months or years. It's one of the biggest costs of aging, and one of the biggest surprises: Medicare doesn't pay for it, at home or in a nursing home. Medigap doesn't either.

What Medicare does cover

• Short-term skilled nursing care after a qualifying hospital stay, up to 100 days per benefit period.
• Part-time skilled care at home if you're homebound, and hospice care.

Ways people pay for long-term care

• Medicaid is the largest payer of long-term care, including nursing homes and, in most states, some care at home. You must meet your state's income and asset rules.
• PACE (Program of All-Inclusive Care for the Elderly) covers medical care and long-term services so people can stay in the community. You must be 55 or older, live in a PACE area, need nursing-home-level care as certified by your state, and be able to live safely at home with PACE's help. It's available in some states.
• Long-term care insurance is a private policy you buy, ideally years before you need it; premiums rise with age and health.
• Veterans' benefits may help eligible veterans with nursing home or in-home care.
• Savings and family pay for much of it in practice.

Plan ahead

Your state's Medicaid office or SHIP counselors can explain your state's rules. For Medicaid planning, an elder law attorney can help.