Does Medigap Cover Long-Term Care?

Medigap policies, also known as Medicare Supplement Insurance, generally do not cover long-term care services. Understanding the distinct differences between Medigap coverage and long-term care is important for financial planning, as relying solely on Medigap for extended care could lead to significant out-of-pocket expenses.

Medigap Coverage Explained

Medigap policies, also known as Medicare Supplement Insurance, work with Original Medicare (Part A and Part B). These supplemental plans, sold by private companies, help cover Original Medicare’s out-of-pocket costs, such as deductibles, copayments, and coinsurance. For example, Medigap plans can help pay the Medicare Part A hospital deductible ($1,676 per benefit period in 2025) and the Part B coinsurance (typically 20% of the Medicare-approved amount for doctor visits and outpatient services).

The primary focus of Medigap coverage is acute medical care, including hospital stays, doctor visits, and certain short-term skilled nursing facility care. While Medigap plans are standardized, they primarily fill gaps in Original Medicare’s coverage for medically necessary services.

Medigap policies do not cover long-term care services. They also exclude private-duty nursing, vision, dental, hearing aids, or most prescription drugs.

Defining Long-Term Care

Long-term care refers to a broad range of medical and non-medical services provided to individuals who cannot perform routine daily activities independently due to chronic illness, disability, or cognitive impairment. These services help people maintain their quality of life over an extended period and are distinct from acute medical care, which focuses on treating illnesses or injuries for recovery.

Long-term care involves assistance with Activities of Daily Living (ADLs), such as bathing, dressing, eating, toileting, and transferring. It also includes Instrumental Activities of Daily Living (IADLs), which are more complex tasks for independent living like managing medications, preparing meals, finances, housekeeping, and transportation. Care can be provided in various settings, including an individual’s home, assisted living facilities, adult day care centers, or skilled nursing facilities, depending on the level of assistance required.

Funding Long-Term Care

Given that Medigap policies do not cover comprehensive long-term care, individuals typically rely on several other funding sources. Personal savings and assets are a common initial means to pay for these services, utilizing funds from retirement accounts, investments, or the sale of property. However, the substantial costs of long-term care can quickly deplete personal resources.

Medicare provides limited coverage for skilled nursing facility care, but only for a short period after a qualifying hospital stay of at least three consecutive days. Medicare Part A may cover 100% of the costs for the first 20 days in a skilled nursing facility, followed by a daily coinsurance amount (e.g., $209.50 per day in 2025) for days 21 through 100. After 100 days, Medicare generally ceases to cover skilled nursing care, and it does not cover custodial care, which is the type of non-medical assistance often associated with long-term care.

Medicaid, a joint federal and state program, serves as a significant payer for long-term care services for those with limited income and assets. Eligibility for Medicaid long-term care is needs-based, meaning individuals must meet specific financial and functional criteria, such as requiring a nursing home level of care or assistance with ADLs.

Finally, private long-term care insurance is a dedicated financial product specifically designed to cover the costs of various long-term care services, including in-home care, assisted living, and nursing home care. This type of insurance can help protect personal assets and provide more choices regarding care settings and services.