Last reviewed: 6 October 2026
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Medicare and long-term care: what Medicare.gov and the federal regulations say is and is not covered
The short answer: Medicare generally does not pay for long-term (custodial) care: Medicare.gov says "Medicare doesn't pay for long-term care" and that you pay all costs for non-covered services, including most long-term care.[1] The federal regulation excludes custodial care, meaning any care that does not meet the requirements for skilled nursing facility (SNF) care, except as needed for palliation or management of terminal illness under the hospice rules.[2] Medicare Part A can cover skilled nursing facility care for a limited time if you meet specific conditions, including a prior inpatient hospital stay of at least 3 days in a row.[3][4]
The short version
- Medicare.gov: long-term care includes medical and non-medical care for people with a chronic illness or disability, and most of it helps with basic personal tasks of everyday life.[1]
- Medicare.gov says Medicare and most health insurance, including Medigap, do not pay for long-term care services, including care in a nursing home or in the community.[1]
- Skilled nursing facility care after a hospital stay is different. Part A covers it only for a limited time, on conditions.[3][4]
What Medicare.gov calls long-term care
- It uses the terms "custodial care" and "long-term services and support" for it.[1]
- It lists personal care assistance (dressing, bathing, using the bathroom), home-delivered meals, adult day health care and transportation as examples.[1]
- It says you may be eligible for long-term care through Medicaid, if you meet your state's eligibility requirements, or you can choose to buy private long-term care insurance.[1]
What the regulation says
- Section 411.15(g) of 42 CFR excludes from Medicare payment "custodial care, except as necessary for the palliation or management of terminal illness, as provided in part 418 of this chapter."[2]
- The same paragraph adds, in parentheses: "Custodial care is any care that does not meet the requirements for coverage as SNF care as set forth in §§ 409.31 through 409.35 of this chapter."[2]
When Medicare does cover skilled nursing facility care
Medicare.gov describes skilled care as nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel.[3] The regulations set these conditions:
| Condition | What the source says | Source |
|---|---|---|
| Prior hospital stay | The beneficiary must have been hospitalized for medically necessary inpatient care for at least 3 consecutive calendar days, not counting the date of discharge. Medicare.gov says time under observation or in the emergency room before admission does not count. | [4][3] |
| Pre-admission entitlement | The beneficiary must have been discharged from the hospital or critical access hospital in or after the month he or she attained age 65, or in a month for which he or she was entitled to hospital insurance benefits on the basis of disability or end-stage renal disease, in accordance with part 406. | [4] |
| Admission timing | Generally the beneficiary must be admitted to the facility and receive the needed care within 30 calendar days after discharge from the hospital. The regulation lists exceptions. | [4] |
| Level of care | The beneficiary must require skilled nursing or skilled rehabilitation services, or both, on a daily basis, for a condition connected to the hospital stay, and the daily skilled services must be ones that, as a practical matter, can only be provided in a SNF on an inpatient basis. | [5] |
| Length | Up to 100 days in each benefit period after discharge. A benefit period begins on the day the beneficiary first receives inpatient hospital, inpatient CAH or SNF services after becoming entitled to hospital insurance, and ends after at least 60 consecutive days as a non-inpatient of those facilities.[6] For the first 20 days Medicare pays for all covered services. For days 21 through 100, it pays for all covered services except a daily coinsurance amount that is the beneficiary's responsibility. | [7] |
| Renewal | The entitlement to the 100 SNF days is renewed each time the beneficiary begins a benefit period. | [7] |
Medicare.gov also says you may not need the 3-day inpatient stay if your doctor participates in an Accountable Care Organization approved for a "Skilled Nursing Facility 3-Day Rule Waiver," and that a Medicare Advantage plan may waive it; it says to ask your doctor or the hospital whether Medicare will cover a stay.[3] This page does not state the daily coinsurance dollar amount; Medicare.gov's SNF page lists the current daily amount, and says days beyond 100 in a benefit period are paid entirely by you.[3]
Why the two are easy to confuse
Medicare.gov says "Long-term care is different from skilled nursing facility care" and that most long-term care is non-medical.[1] The regulation says posthospital SNF care is covered only for days when the person needs and receives the level of care it describes, so the test is the care required, and care that does not meet the SNF requirements is custodial.[4][2]
If you are being sold something
Our guides cover the rules for producers who sell long-term care insurance: the suitability and replacement rules and the Partnership program training. A claim that Medicare will pay for ongoing custodial care does not match what Medicare.gov and the regulation say above.
How to verify this yourself
Read the "Long-term care" and "Skilled nursing facility (SNF) care" pages on Medicare.gov and then 42 CFR 411.15(g), 409.30, 409.31 and 409.61 on the eCFR. For your own situation, Medicare.gov says to ask your doctor or hospital staff whether Medicare will cover a SNF stay.
What this page does not cover
We do not say whether you need long-term care insurance, how much it costs, how Medicaid eligibility works, or how to plan for care costs. We do not cover home health care or hospice benefits beyond naming the hospice exception, Medicare Advantage plan rules for SNF care, or the current dollar amounts of coinsurance. Medicare rules and amounts can change. This is general information, not insurance or legal advice. For your own situation, ask your agent or insurer, or contact your state insurance regulator.
Your next step
If you or a relative may need care after a hospital stay, ask the hospital in writing whether the stay is classified as inpatient or observation, because only inpatient days count toward the 3-day requirement. Our Medicare Parts A, B, C and D guide lists what each part is.
Related checks
Our standard explains how we check an agent's license and disciplinary history. Check an agent reports our findings at category level, as a method and not a verdict. Neither reviews any insurer, plan or product. For who sells Medicare-related plans and how to check them, see Medicare Advantage agent certification. More plain-language guides are in the agent guides.
When we will update this page
We re-read the sources when they change. If something here is out of date, tell us. Corrections are dated on the page.
References
- [1] Medicare.gov, "Long-term care" (coverage), read 6 October 2026 — medicare.gov/coverage/long-term-care
- [2] Electronic Code of Federal Regulations, 42 CFR § 411.15 (particular services excluded from coverage), read 6 October 2026 — ecfr.gov/current/title-42/section-411.15
- [3] Medicare.gov, "Skilled nursing facility (SNF) care" (coverage), read 6 October 2026 — medicare.gov/coverage/skilled-nursing-facility-snf-care
- [4] Electronic Code of Federal Regulations, 42 CFR § 409.30 (SNF basic requirements), read 6 October 2026 — ecfr.gov/current/title-42/section-409.30
- [5] Electronic Code of Federal Regulations, 42 CFR § 409.31 (level of care requirement), read 6 October 2026 — ecfr.gov/current/title-42/section-409.31
- [6] Electronic Code of Federal Regulations, 42 CFR § 409.60 (benefit periods), read 6 October 2026 — ecfr.gov/current/title-42/section-409.60
- [7] Electronic Code of Federal Regulations, 42 CFR § 409.61 (general limitations on amount of benefits), read 6 October 2026 — ecfr.gov/current/title-42/section-409.61
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