Long-term care insurance, and what Medicare doesn’t pay
Most long-term care is help with everyday tasks, and Medicare doesn’t pay for it. Let me answer the questions people ask about it, using Medicare.gov, the federal Administration for Community Living and Florida’s insurance regulator.
Jeannie Pond, Licensed Insurance Agent, NPN 8940178, licensed since 2009
No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana
Long-term care is help with the basic personal tasks of everyday life, like bathing and dressing, at home, in the community, in assisted living or in a nursing home. Medicare doesn’t pay for long-term care, and neither does Medigap. Long-term care insurance is designed to cover these services: a policy pays a daily amount up to a limit you choose, and its premium depends on your age when you buy and the benefits you pick.
My answers come from Medicare.gov and Florida’s regulator. Read a policy’s Outline of Coverage before you buy.
What counts as long-term care?
Long-term care, also called custodial care, is medical and non-medical care for people who have a chronic illness or disability. Most of it helps with the basic personal tasks of everyday life, called activities of daily living.
Florida’s Department of Financial Services lists six of them: bathing, continence, dressing, eating, toileting and transferring, which means moving into or out of a bed, chair or wheelchair. People with a cognitive impairment usually need supervision, protection or verbal reminders to do everyday activities.
The care can happen at home, in the community, in an assisted living facility or in a nursing home.
Medicare.gov: Long-term careWhere does Medicare stop paying?
Medicare doesn’t pay for long-term care. You pay all costs for services it doesn’t cover, including most long-term care. And long-term care is different from skilled nursing facility care.
So where’s the line? Medicare pays only when you need skilled services or rehabilitative care: in a nursing home for at most a hundred days, though the average covered stay is much shorter, at twenty-two days, or at home when you also get skilled home health services. It does not pay for non-skilled help with activities of daily living, which make up most long-term care.
What Medicare pays, by the kind of care
Skilled or rehabilitative care in a nursing home
The average covered stay: 22 days
At most 100 days
Days in a nursing home, drawn to scale
Non-skilled help with activities of daily living, such as bathing, dressing and eating
Medicare doesn’t pay for it, and it makes up most long-term care.
And Medigap?
Medicare Supplement Insurance generally doesn’t cover long-term care, like care in a nursing home. What a Medigap policy does cover is on its own page.
And Medicaid?
You may be eligible for long-term care through Medicaid if you meet your state’s eligibility requirements. In Florida, the Department of Children and Families decides Medicaid eligibility.
If Medicare doesn’t pay, who does?
The Administration for Community Living points to consumer surveys that reveal common misunderstandings about which public programs pay for long-term care. The plain rule: you’ll have to pay for long-term care services that aren’t covered by a public or private insurance program.
Medicaid pays for the largest share of long-term care services. To qualify, your income must be below a certain level and you must meet your state’s minimum eligibility requirements, which are based on how much help you need with activities of daily living. In Florida, Medicaid covers you only in Medicaid-approved nursing homes that provide the level of care you need, pays for home health care only under certain circumstances, and has complex rules.
Private sources of payment have their own rules, eligibility requirements, copayments and premiums for the services they cover. Long-term care insurance is one of them, and reverse mortgages are another.
And other federal programs?
Other federal programs, such as the Older Americans Act and the Department of Veterans Affairs, pay for long-term care services, but only for specific populations and in certain circumstances.
And your health insurance?
Most employer-sponsored or private health insurance covers only the same kinds of limited services as Medicare. If it does cover long-term care, it is typically only skilled, short-term, medically necessary care.
Other private ways people pay for long-term care include life insurance options and annuities. You’ll find every kind of coverage I explain on the services page.
ACL: Who pays for long-term care?What does a long-term care policy pay for?
Long-term care insurance is designed to cover long-term services and supports, including personal and custodial care at home, in a community organization or in another facility. A policy reimburses a daily amount, up to a limit chosen ahead, for help with activities such as bathing, dressing or eating.
Policies aren’t standardized, though. Some pay benefits only in a nursing home, some only at home, others both, and many also cover adult day care, assisted living or other community facilities. Home health coverage varies too: some policies pay only for skilled care from nurses and therapists in your home.
In Florida, a policy can’t make benefits harder to get than being unable to perform three of the six activities of daily living. Every insurer must give you an Outline of Coverage that explains its terms, benefits and exclusions.
ACL: What is long-term care insurance?What do you choose when you apply?
In Florida, you make three choices: the daily benefit amount, the maximum benefit period, and the elimination period, which is the number of days you wait before benefits begin. The longest elimination period allowed is one hundred eighty days.
The benefit may be a set dollar amount or a number of years, months or days. Many policies limit how long or how much they pay. Some pay for two to five years, others pay for as long as you live, and very few have no such limits.
Once a policy is delivered, you have thirty days to review it and return it for a full refund.
The three choices, in the order a policy pays
Dashed: the wait, before benefits begin
The elimination period
The days you wait before benefits begin. In Florida, at most 180 days.
The daily benefit amount
Benefits begin: a daily amount, up to the limit you chose.
The maximum benefit period
Many policies limit how long or how much they pay. Some pay for two to five years.
Or for life
Other policies pay for as long as you live. Very few have no such limits.
What should you check in Florida, before and after you buy?
Florida’s Department of Financial Services publishes a Long-Term Care Guide for anyone shopping for a policy. It explains the coverage and your rights and responsibilities, and lists questions to consider when you buy. Its advice for reading a policy is simple: understand your coverage, where the care will be provided, when it starts and how long it lasts.
Look for any rule about a prior hospital stay. In Florida, an insurer may require one first only for waiver of premium, post-confinement, post-acute care or recuperative benefits, and the policy must state those limits in a separate paragraph titled “Limitations or Conditions on Eligibility for Benefits.” Policies sold before 1992 may still contain a hospitalization requirement.
Know what is and isn’t insurance. Homemaker service contracts are not insurance, so you have no protection if the company goes out of business.
Name a second person for lapse notices
The company must offer you the option to list a Secondary Addressee who also receives lapse notices. It cannot cancel for nonpayment without sending the notice of lapse 30 days before, and an individual policy must allow a 30-day grace period for paying the premium.
If a lapse was not on purpose
You can have the policy reinstated within 5 months after cancellation if the lapse was unintentional and the policyholder was diagnosed with a cognitive impairment or a loss of functional capacity (Florida’s FAQ).
If a rate increase letter arrives
The company will provide several options to help make your coverage more affordable. If they are confusing, call the number listed in the letter to understand each option and how it affects your coverage.
If a claim is slow
Contact the company to find out what is causing the delay. If you’ve confirmed that every requested document was sent, you can submit an insurance concern with the Department, or call the Florida Insurance Consumer Helpline at 1-877-693-5236.
My license numbers, by state
Jeannie Pond, Licensed Insurance Agent, NPN 8940178. Florida W272782; Arizona 8940178; California 4524185; Georgia 2669678; Indiana 4017600 (health only); Michigan 8940178; New Jersey 3004406991; North Carolina 8940178; Tennessee 960426; Texas 1617709; Virginia 1447142 (health only); Washington 1346341.
Jeannie Pond has been a licensed insurance agent since 2009.
Jeannie Pond ofrece seguros de vida, anualidades, seguros de gastos finales y cobertura de cuidado a largo plazo.
Check the agent’s license and the insurance company’s before you sign an application for a policy. Start with mine: each number can be looked up on the state’s insurance license search.
No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana
Ask me about long-term care: common questions
Does Medicare pay for long-term care?
No. Medicare.gov, as of October 2026, says Medicare doesn’t pay for long-term care, meaning mostly non-medical help with everyday tasks such as bathing and dressing, and that you pay all costs for services it doesn’t cover. Where long-term care is concerned, Medicare pays only when you need skilled services or rehabilitative care, and then for a limited time, such as a nursing home stay of at most a hundred days. Medigap generally doesn’t cover long-term care either.
How much does long-term care insurance cost?
It depends on your age when you buy, the most the policy pays per day, how many days or years it pays, any optional benefits such as inflation increases, and whether the insurer accepts you after medical underwriting. Your actual figure comes from the insurer’s quote, and the premium can rise later with the state’s approval. When you first get in touch, I’ll go over your own situation.
What can disqualify someone from long-term care insurance, and is there an age limit?
It depends on the insurer’s underwriting. If you’re in poor health or already receiving long-term care services, you may not qualify, because most individual policies require medical underwriting. Some group policies don’t, and in some cases a limited amount of coverage or a higher non-standard rate is offered. The insurer’s application and the policy itself say whether your age or health would keep you from qualifying. Ask me about your own case when you first reach me.
What are the drawbacks of long-term care insurance?
It depends on the policy, but here’s what to watch. Many policies limit how long or how much they pay, the insurer may raise the premium after you buy, policies are not standardized, so coverage at home or in a nursing home varies, and benefits begin only after the elimination period you choose. Read the Outline of Coverage and ask for the company’s premium rate history before you buy. I’ll answer for your own situation when you first get in touch.
Thinking about care down the road? Talk it over with me.
Send me your name and the best way to reach you, or give me a call.Medicare help in Lakeland and nearby cities
No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana
Jeannie Pond, Licensed Insurance Agent, NPN 8940178. Florida W272782; Arizona 8940178; California 4524185; Georgia 2669678; Indiana 4017600 (health only); Michigan 8940178; New Jersey 3004406991; North Carolina 8940178; Tennessee 960426; Texas 1617709; Virginia 1447142 (health only); Washington 1346341.
Vista Consultants LLC dba Vista Insurance Services holds Florida insurance agency license L135539 (agency NPN 22164003), issued March 19, 2026, with Jeannie Pond as agent in charge.