When considering long-term care for yourself or a loved one, one of the first questions that comes to mind is: “Is long-term care covered by insurance?” The answer depends on several factors, including the type of insurance you have, the setting in which you receive care, and the specific services you need.

Understanding how long-term care coverage works can help you plan and avoid unexpected financial burdens.

What Is Long-Term Care?

Long-term care includes a range of services designed to support individuals who need assistance with medical and non-medical needs due to a chronic illness, disability, or age-related challenges. The type of services you receive depends on the type of long-term care needed and the setting in which it will be provided. 

Long-Term Care Services May Can Include:

• Assistance with Activities of Daily Living: Help with bathing, dressing, eating, and mobility.
• Medical Support: Skilled nursing care, medication management, and rehabilitation therapies.
• Specialized Programs: Disease-specific programs for COPD, CHF, and Diabetes Dementia.
• Care Management: Provides effective planning and coordination of services to help ensure individuals living at home or residents of a skilled nursing center receive the care they need. 

Does Health Insurance Cover Long-Term Care?

Medicare

Medicare, the federal health insurance program primarily for individuals 65 and older, does not typically cover long-term care. However, it may cover:

• Short-term skilled nursing care after a hospital stay (up to 100 days in some instances).
• Some home health care services, if deemed medically necessary.

Beyond these limits, Medicare will not cover long-term assistance with activities of daily living (ADLs), including bathing, dressing and eating (also known as custodial care.)

Learn More About Medicare and Long-Term Care.

Medicaid

Medicaid, a joint federal and state program, does cover long-term care services for medically-eligible individuals with low income and limited assets. Coverage varies by state, but in New York typically includes:

• Long-term care at home, including assistance with activities of daily living at home.
• Nursing home care.

To qualify, applicants must meet specific medical criteria as well as strict income and asset limits, which often require individuals to spend down their savings before becoming eligible.

To learn more about Medicaid Long-Term Care Eligibility and Requirements, visit Your state Medicaid Site.

Dual Medicare & Medicaid

Individuals who have both Medicare and Medicaid (sometimes known as duals) may also be eligible for long-term care services under a Medicare Advantage Long-Term Care plan. This plan provides medical, hospital, prescription drug and long-term care coverage. 

Veterans Benefits

Veterans may qualify for long-term care benefits through the U.S. Department of Veterans Affairs (VA). These benefits can help cover care in nursing homes, assisted living facilities, and at home for eligible veterans.

For more information, visit the U.S. Department of Veterans Affairs website.

Private Pay and Other Options

For those without insurance coverage or whose insurance does not provide sufficient coverage, long-term care can be paid for through alternative funding options, such as:

• Personal savings.
• Reverse mortgages.
• Long-term care policies.
• Life insurance with long-term care riders.

This information is for educational and directional purposes and is not intended as financial advice. Refer to your local Medicare and Medicaid websites to confirm your coverage details.