Will any Medicare plan pay for long-term care?
October 14, 2026
Listen Now
Subscribe
Go Deeper
Plain-English guides on this topic:
- The Long-Term Care Planning GuideWhat Medicare doesn't cover, and what you can do about it. Arizona, Nevada and national costs, hybrid vs traditional insurance, Medicaid planning, tax benefits, and caregiver impact. 15 pages.
- Long-Term Care PlanningMedicare does not pay for long-term care. What care costs, how families pay for it, and the two triggers every policy should include.
Ready to talk with an advisor?
The advisors at American Retirement Advisors have been having these conversations for over 25 years. A no-cost discovery session is the fastest way to find out where you actually stand.
Schedule a Discovery Session
Show Notes
Eddie and Betty's Conversation
Welcome to The American Retirement Advisor. I'm Betty, and Eddie's here with me in the studio today, which is great because we are diving into a topic that I think genuinely catches people off guard. It's about Medicare, what it covers, and specifically this one giant thing that it does not cover, which is long-term care. Ian Schaeffer wrote a piece about this recently and there's a number in the first sentence that stopped me cold.
Oh, that one. Yeah, I saw it too and I had to read it twice.
Almost 70. That is the government's own estimate, from their long-term care site, of the chance that someone turning 65 today will need some type of long-term care. That's not a scare tactic from an insurance brochure. That's the federal government.
Right, and what Ian's piece is pointing out is that this number lands right alongside the Annual Enrollment Period, when people are spreading plan cards out on the table. And the cost that 70% figure is pointing to is not on any of those cards.
So let's just say it plainly. Does Medicare pay for long-term care?
No. And that's not us editorializing. The article quotes Medicare's own website saying, and I'm paraphrasing but barely, Medicare doesn't pay for long-term care, and for those services, you pay all costs.
That is so direct. I appreciate that they just said it.
It's refreshingly blunt for a government website, yes.
And then the article also mentioned Medigap, which a lot of our listeners have. Those supplement policies.
Same answer for that one, too. It does not cover long-term care either. Whether the care is happening at home, in the community, or in a nursing home. So two no's for the price of one.
So what actually is long-term care? Because I think people hear that phrase and picture one specific place, and maybe that's not the whole picture.
Good distinction. Long-term care is help with everyday living, the basics, bathing, dressing, eating, getting in and out of bed. It's for someone with a chronic illness or a disability who needs that help for months or years. It's not the medical treatment Medicare was built for. It's more like daily human assistance.
Which is actually where most of the need is. It's not surgery or a hospital stay. It's an ordinary morning, and someone needs help getting dressed.
Exactly, and that's a very different thing than what Medicare was designed to handle.
Okay, but here's where I think a lot of people get confused. They hear that it covers skilled nursing and they think, well that covers a nursing home, so I'm fine.
It's one of the biggest misconceptions out there. That coverage under Medicare is a short, specific benefit. And the conditions around it are pretty tight.
Walk me through just how narrow we're talking.
So you have to have an inpatient hospital stay of at least three days in a row first. Then you generally have to go into a skilled nursing facility within 30 days of leaving the hospital. And you have to need daily skilled care, like physical therapy after a surgery. That's the picture they're describing.
So it's a recovery benefit. You had a hip replacement, you spend a few weeks in rehab. That's the scenario.
That's exactly how it plays out. And for 2026, the first 20 days cost you nothing after the Part A deductible. Days 21 through 100, you're paying $217 a day. After day 100, you pay everything.
Wait, $217 a day starting on day 21?
Yep. So the benefit is real but it has a defined ceiling, and it is built for recovery, not for years of help with daily living. Those are two fundamentally different things.
Right, and seeing the words skilled nursing on your plan card does not mean long-term care is covered. I think that's the sentence in Ian's article I want to just put on a billboard.
It's doing a lot of heavy lifting for a lot of people who haven't read the fine print.
Okay, let's talk about what this costs, because I think most of us do not know.
This is where the article gets uncomfortable in the best way. Ian cites a 2025 Cost of Care survey and the national median for a nursing home private room is a hundred and twenty-nine thousand dollars a year.
Per year.
Per year. The semi-private room is just under a hundred and fifteen thousand. Assisted living is around seventy-four thousand a year. And home care, which sounds like the more affordable option, runs about eighty thousand a year if you're talking 44 hours a week at thirty-five dollars an hour.
So home care is not as cheap as people assume.
Not even close. And those are national medians. If you're in a higher cost-of-living area, higher.
And these aren't one-time costs. The whole question is how long someone needs care.
Which is where the article has another number I found really striking. The government's long-term care site says women who need care need it for an average of 3.7 years. Men, 2.2 years. And 20% of people need it for longer than five years.
So one in five. And if you're doing the math in your head right now, five of those at that number we just talked about, that staggering annual cost for a private room, is...
That rearranges a retirement plan. Yes.
I think for couples especially, what Ian's article does that I really appreciated is it reframes whose problem this is. It's not just about the person who needs care.
That's what gets overlooked in these conversations. If one spouse requires years of care, the income and savings the healthy spouse depends on are the ones most at risk. So the real question for a couple isn't just who pays for care. It's what does the other spouse have left to live on.
That's a really different way to frame it. And kind of a harder thing to sit with.
Which is why Ian says it belongs in the same conversation as your retirement income plan and your inheritance plan, not in a separate drawer somewhere you forget about.
Okay so if Medicare isn't the answer, what are the options? Because people do have to do something.
The article lays out a few. First is just paying out of your own savings, which gives you maximum control but also puts the most of your money at risk. Second is Medicaid, which does cover long-term care.
But it has rules.
Strict ones. Income limits, asset limits, and those vary by state. So whether Medicaid is even an option for someone depends heavily on where they are financially and where they live. Our advisors at American Retirement Advisors would know the specifics for your state, I'd write that question down and bring it to them rather than guessing.
What about private long-term care insurance?
That's the third option, a policy you buy ahead of time that pays toward care once certain conditions are met. And then there's what the article calls hybrid coverage, where some life insurance policies and annuities include long-term care benefits built in, so the coverage is doing a job whether or not care is ever needed.
That's an interesting idea, that the money isn't wasted if you end up not needing long-term care.
Right, it removes the 'what if I pay premiums for years and never use it' concern. Though the specifics of how those work, what the triggers are, what it pays, those are questions for someone who can look at the actual policy.
Which brings up something else in Ian's piece that I thought was practical. The question of how a policy starts paying. Because I think people assume you just get sick and the check arrives.
If only. There are two things that have to happen. First, a benefit trigger, which is usually either needing help with two or more of six activities of daily living, or having a cognitive impairment. Most policies use those two triggers. And then even after that, there's an elimination period.
Which is?
It's a waiting period after the trigger, before the policy starts paying. Often 30, 60, or 90 days, chosen when you buy the policy. And during that waiting period, you're covering the cost of care yourself.
So at, let's say, thirty-five dollars an hour, ninety days of care at home is not nothing.
And that cost adds up fast. This is why if you already own a long-term care policy, Ian's article has a really useful set of questions you should be able to answer about your own policy right now.
What are the triggers, how long is the elimination period, and does the benefit grow over time. Those are the three I remember from the article.
Right, and inflation matters a lot here because if you bought a policy fifteen years ago with a fixed benefit, today's costs may have outpaced what the policy pays.
Good point. Okay, let's talk about timing, because the Annual Enrollment Period starts tomorrow and people are focused on plan cards and formularies and network questions, all of which matter.
Annual enrollment runs October 15 through December 7, and it's absolutely the right time to think about which plan fits your doctors and prescriptions for 2027. Ian's article isn't saying skip that. He's saying just be clear on what the plan card covers and what it doesn't.
And long-term care is not on the plan card. That's the whole point of the piece.
He puts it really well. Long-term care is a planning question, not a plan-card question. Those are two different conversations and they both need to happen.
I like that framing. Pick your plan, and then separately, have the longer conversation about what happens if care is needed.
And the article is careful to say none of this requires a decision this week. It's something to work through before anyone needs care, not a panic response.
The questions it suggests for couples to start with are good. Like, if one of you needed help at home, who would provide it? And for how long could they realistically do that?
That one gets real fast. Because the answer is often a spouse or an adult child, and there are real limits on how long that's sustainable, emotionally and logistically.
And then the question about which savings would pay for care, and what that does to what's left for the other person.
That's the math most couples have never done.
So if someone is listening and they want to work through this, what's the next step?
Ian's article mentions that American Retirement Advisors has a one-page guide on this, it's part of their new library, and you can go through it with an advisor. The number is 602-281-3898.
I want to do a quick recap of the numbers that I think everyone should just have in their head after today, because they're striking on their own.
Go for it.
And when you sit with that number the government gave us, nearly 70% of us facing that reality, and then you stack on top of it that price tag we just talked about, nearly a hundred and thirty thousand dollars a year at the national median, women averaging 3.7 years of care, one in five people needing more than five years... and Medicare covers zero of that ongoing cost. That's a lot to absorb all at once.
Zero. That's the whole article in four numbers.
You're welcome, Ian.
He did the hard work, we just read it out loud.
Discussed it. We discussed it. You're terrible at accepting compliments on behalf of other people.
It's a skill I'm working on.
To everyone listening, if you're sitting at the table right now with your Medicare plan cards spread out, good. Do that work, it matters. And then, separately, have the long-term care conversation. Not because it's fun, it isn't, but because the alternative is having it in a hospital waiting room under pressure, and that's a much harder place to make good decisions. Reach out to American Retirement Advisors at 602-281-3898. Thanks for being here with us today.