The Truth About Whether Long-Term Care Is Ever Covered by Medicare

Given how confusing Medicare can be, getting signed up can feel like taking a master's class in healthcare coverage. Figuring out what's covered, what's not, and how much you'll need to pay out of pocket can be tricky.

Long-term care is a particularly tough topic for those planning for healthcare in retirement. Here's a quick breakdown of when you can count on Medicare to kick in and when you can't.

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Long-term care

Medicare doesn't cover long-term skilled nursing care and nursing home stays. If you move into an assisted living facility because you need help with activities of daily living (ADLs) -- such as bathing, dressing, or eating -- Medicare won't pay for it. The same is true if you go into a nursing home or similar facility or receive long-term services in your own home.

Knowing that you're on your own when it comes to paying for long-term care is important information to have when it comes to planning for retirement. However, that doesn't mean that Medicare will never help.

When Medicare does kick in

Medicare Part A covers inpatient hospital services. And if your doctor sends you to a Medicare-certified skilled nursing facility (SNF) for specialized nursing care and/or rehabilitation following a hospital stay, Medicare will often pay for that short-term stay.

There is one catch. Care in a skilled facility is covered only if you had a "qualifying hospital stay." The term qualifying hospital stay means you were formally admitted as an inpatient to a hospital for at least three consecutive days. It doesn't apply if you were admitted for observation status -- even if you spent the night in the hospital.

In addition, for Medicare to kick in, you must be admitted to the skilled nursing facility within 30 days of leaving the hospital and be admitted to the nursing facility for the same condition you were hospitalized for.

Covered services

Once admitted to a skilled nursing center following hospitalization, here's a small sample of the services Medicare will cover:

• A semi-private room
• Meals
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medications

Out-of-pocket costs

How much you'll need to take from a retirement account or other savings to pay for short-term stay in a skilled nursing facility depends on how long you're there and the type of Medicare plan you have. For example, if you're in a Medicare Advantage Plan, you may be charged copayments during the first 20 days. To know for sure what you'll owe, check with your specific plan for more information. Otherwise, here's what you can expect to pay:

• Days 1 through 20: You pay a $1,736 deductible (unless you already paid it for the care you receive in the hospital). Beyond the deductible, you pay $0 for days 1 through 20.
• Days 21 through 100: You pay $217 per day.
• Days 101 and beyond: You're responsible for all costs.

Bottom line

While Medicare may help cover the cost of a short-term stay in skilled nursing, the cost of long-term care -- should you ever need it -- will still come out of your pocket.

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