When you’re planning for retirement, there’s comfort in knowing Medicare will be there for you. After all, you’ve paid into it for decades, and it’s designed to cover many of your healthcare needs as you age. But one of the biggest gaps in that coverage—one that often catches people off guard—is long-term care.
We’re not talking about a short stay in a rehab facility or help recovering from surgery. We’re talking about ongoing care: support with daily living, help getting dressed, bathing, eating, or managing life with dementia. This type of care can last for years and is something most people will need at some point in life. Here’s the part that surprises many: Medicare doesn’t cover it.
What Exactly Is Long-Term Care?
Long-term care is assistance with daily living—not medical treatment. It’s for people who are no longer able to care for themselves independently due to chronic illness, disability, or cognitive decline.
According to Medicare, long-term care is defined as: “A range of services and support for your personal care needs. Most long-term care isn’t medical care. Instead, it helps with basic personal tasks of everyday life, sometimes called ‘activities of daily living.’”
This typically includes help with:
- Bathing
- Dressing
- Eating
- Using the toilet
- Walking or transferring
- Medication reminders
- Supervision for cognitive conditions like dementia
This care may take place at home, in an assisted living facility, or in a nursing home. Regardless of the setting, what matters to Medicare is the type of care being delivered. And if it’s primarily custodial rather than medical, it falls outside Medicare’s coverage.
Why Medicare Doesn’t Cover Long-Term Care
Medicare was designed to cover acute, medically necessary care—things like doctor visits, hospital stays, surgeries, and rehabilitation. It does a good job with that. But once a condition becomes chronic and care shifts from treatment to assistance, Medicare steps back.
Here’s what Medicare may cover:
- Short-term skilled nursing care following a hospitalization
- Physical therapy, occupational therapy, or speech therapy when prescribed
- Hospice care for end-of-life support
- Some home health care, if there’s a skilled medical need involved
But here’s what Medicare does not cover:
- 24/7 in-home care
- Long-term stays in a nursing home for custodial needs
- Assisted living or personal care services
- Help with cooking, cleaning, laundry, or transportation
Even when care is essential for quality of life or safety, if it’s not medically necessary or part of a short-term recovery, Medicare won’t pay.
How Likely Are You to Need Long-Term Care?
The numbers are eye-opening. If you’re 65 or older:
- You have a 70% chance of needing long-term care services in your lifetime
- For women, the average length of care is 3.7 years
- For men, it’s slightly less at 2.2 years
- The average across all adults is 3.2 years of care
These aren’t short-term needs—they’re multi-year realities. And they affect nearly everyone at some point, either personally or as a caregiver.
What Does Long-Term Care Cost?
Long-term care is expensive—regardless of where you live or what type of care you need.
On average:
- A private room in a nursing facility costs around $9,000 per month or $108,000 per year
- A semi-private room averages about $8,000 per month or $96,000 per year
- In-home care or assisted living can vary, but still often runs $4,000–$6,000 per month
And remember, with an average stay of more than three years, these costs can easily climb above $300,000 per person.
Some high-cost states like New York, Connecticut, and Alaska report average nursing home costs exceeding $13,000 per month, while more affordable states like Missouri, Texas, and Oklahoma may see monthly costs closer to $5,000.
Either way, the numbers add up quickly.
Who Pays for Long-Term Care?
Since Medicare doesn’t foot the bill, where does the money come from? Here’s how long-term care expenses are generally covered in the U.S.:
- 47% is paid by Medicaid (for those who meet strict income and asset requirements)
- 23% is paid out-of-pocket by individuals and families
- 23% is covered by Medicare, but only in specific short-term, medically necessary situations
- 4% is covered by Veterans Affairs benefits
- Just 3% is paid by long-term care insurance
In other words, if you don’t qualify for Medicaid and you don’t have a long-term care insurance policy, the burden of cost will likely fall on you or your family.
How to Prepare for What Medicare Doesn’t Cover
The earlier you start planning, the more options you’ll have. Many people delay thinking about long-term care because it’s uncomfortable or seems far off. But putting a plan in place now can save you and your loved ones enormous stress later on.
Here are a few smart next steps:
- Understand what Medicare does and doesn’t cover. Knowing the limits of your coverage will help you avoid surprise expenses later.
- Look into long-term care insurance. If you’re in your 50s or early 60s and in good health, this may be a cost-effective way to protect your assets and gain peace of mind.
- Consider Medicaid planning. If you’re closer to needing care or have limited resources, speak with an elder law attorney or planner about how to qualify without sacrificing everything you’ve saved.
- Talk with your family. Be open about your wishes. Do you want to age at home? Are you willing to consider assisted living? These conversations are easier when they happen early.
Don’t Wait for a Crisis
Too often, families don’t face these realities until they’re already in the middle of a health emergency. At that point, choices are limited and emotions are high. Long-term care isn’t just a financial issue—it’s a quality-of-life issue. Planning for it now can give you more control, more dignity, and more peace of mind later.
Medicare School helps people every day understand where Medicare coverage ends and how to prepare for what comes next. If you have questions about long-term care, what Medicare covers, or how to build a plan that fits your future, we’re here to help.
Schedule a free call at a time that works for you with one of our licensed Medicare Guides, or call us directly at 800-864-8890. We’ll explain everything clearly and honestly, so you can focus on what matters most—your recovery.