Does Medicare Cover Housing or Long-Term Care?
Understand Medicare's nuanced coverage for medical care in various settings, clarifying what it does and doesn't cover for housing costs.
Medicare, the federal health insurance program, is often a topic of inquiry regarding long-term care and housing costs. Many wonder if it covers rent, mortgage payments, or general living expenses in various care settings. Medicare primarily covers medical services and treatments, meaning it generally does not pay for non-medical personal care or general housing expenses. This article clarifies what Medicare covers and does not cover concerning housing, distinguishing between medical care and other forms of support.
Understanding Medicare’s Coverage Principles
Medicare’s design provides coverage for medical care, including hospital stays, doctor visits, and certain medical supplies, rather than for daily living expenses. This fundamental principle means the program does not cover costs like rent, mortgage payments, utilities, or the room and board portion of assisted living facilities or nursing homes when care is primarily custodial.
A key distinction in Medicare coverage is between medical care and custodial care. Medical care refers to services from healthcare professionals to diagnose, treat, or manage an illness or injury. Custodial care involves non-medical assistance with activities of daily living (ADLs), such as bathing, dressing, eating, or moving. Medicare generally excludes coverage for custodial care when it is the only type of care an individual requires. Therefore, if a person in an assisted living facility only needs help with ADLs, Medicare will not cover their stay.
Medicare Coverage for Skilled Nursing Facility Stays
Medicare Part A can cover a temporary stay in a skilled nursing facility (SNF) under specific conditions, which may include the cost of a semi-private room and meals. This coverage is for short-term, medically necessary skilled care, not long-term residency. To qualify, a beneficiary must have a prior qualifying hospital stay of at least three consecutive days as an inpatient, excluding the discharge day.
Upon admission to an SNF, the care must be for skilled nursing care or skilled therapy services, such as physical therapy, occupational therapy, or speech-language pathology. Medicare covers the full cost for the first 20 days of a covered SNF stay. For days 21 through 100, a daily co-insurance amount applies, which is $209.50 in 2025.
The services covered during a skilled nursing facility stay include a semi-private room, meals, skilled nursing care, various therapies, medications administered in the facility, medical supplies and equipment, and dietary counseling. Coverage ceases after 100 days in a benefit period or if the patient no longer requires skilled care and only needs custodial care. The individual then becomes responsible for all costs, including the room and board.
Medicare Coverage for Home Health Care
Medicare can cover specific home health care services, allowing individuals to receive medical care at home. This coverage is for intermittent skilled medical services, often following an illness, injury, or to manage a chronic condition, helping individuals recover or maintain their condition.
To be eligible, a doctor must certify the individual needs intermittent skilled nursing or therapy services and is considered “homebound.” Being homebound means that leaving home requires a considerable and taxing effort, and the person typically cannot leave without assistance. Covered services include intermittent skilled nursing care, physical therapy, occupational therapy, speech-language pathology, medical social services, and certain home health aide services when tied to skilled care.
Medicare’s home health benefit does not cover all types of in-home support, such as 24-hour care, meal delivery services, or general housekeeping tasks. Additionally, Medicare does not cover the direct costs of the home itself, such as rent, mortgage payments, or utility bills. Coverage is strictly limited to medical and therapeutic services from certified home health agencies.
Medicare Coverage for Hospice Care
Medicare provides comprehensive coverage for hospice care, offering support and comfort for individuals with a terminal illness. This care focuses on palliative treatment rather than curative measures for those with a life expectancy of six months or less. Hospice care aims to manage pain and other symptoms, improving quality of life.
Services covered under Medicare’s hospice benefit include doctor services, nursing care, medical equipment, medications for pain and symptom control, physical and occupational therapy, speech-language pathology, and medical social services. Dietary counseling and grief and loss counseling for the patient and family are also covered. Hospice care can be provided in various settings, including the patient’s home, a dedicated hospice facility, a hospital, or a skilled nursing facility.
While Medicare covers services from the hospice team, it generally does not cover room and board costs in a hospice facility, nursing home, or other institutional setting. An exception exists for short-term inpatient stays for pain management or respite care, where room and board may be covered. If hospice care is provided in the patient’s home, Medicare covers medical and support services, but it does not cover the ongoing costs of living in that home.