Cynthia (Cindy) Couyoumjian is a financial advisor and the founder of Cinergy Financial, a financial planning and investment services firm in Tustin, California. In this post,
Cynthia Couyoumjian answers the questions families ask most often about Medicare and long-term care.
Medicare generally does not cover long-term care. It can help pay for a short stay in a skilled nursing facility or part-time care at home while you recover from an illness or injury, but it does not pay for ongoing help with daily tasks like bathing and dressing when that is the only care you need, as Medicare’s
coverage rules spell out.
This is one of the questions I hear most often at Cinergy Financial in Tustin, and it comes up even more in the fall. Medicare
open enrollment runs from October 15 to December 7, and for many families it is the one time each year they read through their coverage line by line.
We are living longer than our parents did, and more of the cost of care in our later years now rests on our own savings and our families. People turning 65 have close to a 70% chance of needing some type of long-term care services in their remaining years, according to a
2020 estimate from the U.S. Administration for Community Living (ACL). When I wrote
The Silent Retirement Crisis, I kept returning to what people tell me they want most from retirement, which is to keep their independence and dignity and to avoid becoming a burden on their children. Who would help you if you couldn’t manage on your own, and how would that help be paid for?
What Long-Term Care Includes
Long-term care is help with the basic personal tasks of everyday life, such as bathing, dressing and using the bathroom, for people living with a chronic illness or disability. Medicare calls these tasks activities of daily living, and most long-term care is not medical care. Long-term care can also include home-delivered meals and adult day health care, and it can take place at home, in the community, in an assisted living facility or in a nursing home. ACL’s research also shows that more people receive long-term care at home than in facilities.
Medicare’s 100-Day Limit on Nursing Home Care
Medicare pays for nursing home care only for a limited time, and only while you need daily
skilled nursing or therapy. Under Medicare’s skilled nursing rules, Part A may cover up to 100 days of skilled nursing facility care in each benefit period after an inpatient hospital stay of at least three days in a row. In 2026, that care carries no daily charge for days 1 through 20 after the Part A deductible and costs $217 a day for days 21 through 100.
As a hypothetical, suppose your mother spends five days in the hospital as an inpatient after a stroke and then moves to a skilled nursing facility for daily therapy. Medicare may cover that stay while she needs skilled care. If her therapy ends after six weeks and she still needs help eating and dressing, that help is custodial care, and Medicare generally stops paying, even if she stays in the same building.
Families can ask one question before anyone leaves the hospital. Medicare’s guidance notes that hospital observation services can affect skilled nursing coverage and suggests asking your doctor or hospital staff whether Medicare will cover a skilled nursing stay. I would put it in plain words: “Is she an inpatient, or is she here under observation?”
What Medicare Covers at Home
Medicare’s
home health benefit can cover part-time or intermittent care, such as skilled nursing visits and physical therapy, for people who are homebound and under a doctor’s care. Medicare does not pay for 24-hour care at home, meal delivery, homemaker services like shopping and cleaning, or personal care such as bathing and dressing when that is the only care someone needs. When most of the help a person needs at home is with daily tasks, families generally pay for it or provide it themselves.
How Medicaid and Medi-Cal Cover Long-Term Care
Medicaid can cover long-term care for people who qualify under their state’s rules, and in California that program is Medi-Cal. Since January 1, 2026, Medi-Cal has counted assets as well as income for people who are 65 or older, have a disability or live in a nursing home, as the California Department of Health Care Services explains in its
asset FAQ. Because these rules change from time to time, I encourage Orange County families to check the current rules and to talk with an elder law or estate attorney about how they apply.
When Nursing Homes Take Your Social Security Check
Nursing homes don’t automatically take a resident’s Social Security check. When Medi-Cal pays for nursing home care, however, residents generally put most of their monthly income, including Social Security, toward their care as a
share of cost and keep a small monthly personal needs allowance. If you’re married, ask how Medi-Cal’s rules would treat the spouse who stays at home.
How Families Pay for Care
Most families pay for long-term care through one or more of these sources, each with its own tradeoffs:
- Personal savings and income. Paying privately gives the most choice about where and how care happens, and it draws on the hard-earned savings meant to support the rest of retirement.
- Long-term care insurance. A policy can pay toward covered care, and costs, benefits and eligibility vary from policy to policy.
- Medi-Cal. For those who qualify, Medi-Cal can cover care in a nursing home under the income and asset rules described above.
- Family caregiving. Many families provide care themselves, which carries costs of its own in time, income and health.
Medicare Supplement Insurance (Medigap) doesn’t pay for long-term care either.
In Redefining Financial Literacy, I call small, repeatable steps “actionable habits.” For long-term care, four of them can start this month:
- Read your Medicare coverage documents during open enrollment and note what they leave out.
- Write down who would help you if you needed care at home, and talk with them about it.
- Gather the statements for your savings, retirement accounts and any insurance policies in one place.
- Ask an estate attorney whether your durable power of attorney and health care directive are current.
Frequently Asked Questions
Does Medicare pay for assisted living?
Medicare does not pay for long-term care in an assisted living facility, because help with daily activities such as bathing and dressing is custodial care. Assisted living is generally paid for with personal savings or long-term care insurance, and California’s Medi-Cal Assisted Living Waiver can help pay for services for some people who qualify.
Does Medicare Advantage pay for nursing home care?
Medicare Advantage plans usually don’t help pay for nursing home care unless the nursing home has a contract with the plan, and Medicare’s nursing home guidance advises checking with your plan before making any arrangements. During open enrollment, Medicare and California’s free HICAP counseling program can help answer questions about how a specific plan handles nursing home and home care.
Does long-term care insurance cover assisted living?
Under California rules, a long-term care insurance policy that covers nursing home care must also cover care in a residential care facility, the state’s licensing term for assisted living. Home-care-only policies are the exception. Benefit amounts and conditions vary, so a policy’s outline of coverage is the place to check the details.
Are long-term care premiums tax deductible?
Under IRS Publication 502, premiums for a qualified long-term care insurance policy can count as a medical expense up to a yearly limit that rises with age. Medical expenses are an itemized deduction, so the premiums can lower taxes only for people who itemize and whose medical costs exceed the IRS threshold. A tax professional can tell you whether that applies to you.
Long-term care asks us to imagine a time when we will need help, which is why so many of us put off thinking about it. What I have learned since entering the securities industry in 1986 is that the conversations families have early leave them more choices later, and no one has to sort through these rules alone. Long-term care planning is part of the risk management work we do at Cinergy Financial, and our three-step process begins with an introductory meeting to confirm the fit. If you would like to review how long-term care fits into your own plan, we would be glad to talk with you. For a quick summary of the Medicare rules covered here, you can also read our recent release.
Rules and figures in this post are current as of October 2026.
About the Author
Cynthia (Cindy) Couyoumjian is a financial advisor and the founder of Cinergy Financial in Tustin, California. In the securities industry since 1986, she is the author of Redefining Financial Literacy, The Rise of Women and Wealth and The Silent Retirement Crisis, and she writes and speaks about financial literacy, retirement and women’s financial confidence.
Registered Representative offering securities and advisory services through Independent Financial Group LLC (IFG), a registered broker-dealer and investment adviser. Member FINRA/SIPC. Cinergy Financial and IFG are unaffiliated entities.
Content provided for information & education only. It is not meant to be a recommendation to buy or to sell securities nor an offer to buy or sell securities. No investment process is free of risk; no strategy or risk management technique can guarantee returns or eliminate risk in any market environment. There is no guarantee that our investment strategies will be profitable.
