Long-Term Care Series
LTC · Medicare & Medicaid
What Medicare & Medicaid
Actually Pay For
Two of the most common (and dangerous) assumptions about LTC: "Medicare will cover it" and "Medicaid will pick up the slack." Both are mostly wrong — and the gap between assumption and reality is where most families lose everything.
Most state Medicaid asset limits
To qualify for Medicaid LTC coverage in most states, you must have less than $2,000 in countable assets. For middle-class families, this means spending down — selling the house, draining savings, until nothing is left.
Medicare: very limited LTC coverage
What Medicare covers: Up to 100 days of skilled nursing facility care AFTER a qualifying 3+ day hospital stay. Days 1-20: 100% covered. Days 21-100: significant daily co-insurance (about $215/day in 2025). After day 100: zero coverage.
What Medicare does NOT cover: Custodial care (help with ADLs), assisted living, adult day care, in-home help with daily tasks, or any care beyond the 100-day skilled nursing window. The vast majority of LTC need.
Medicaid: covers LTC, but you have to be poor to qualify
Asset limits: Typically $2,000 in countable assets for single applicants. Couples have higher limits (community spouse protection) but rules are complex.
5-year lookback: Medicaid reviews 5 years of financial history. Any transfers or gifts during that period can trigger ineligibility periods. Cannot just give assets to children and apply next month.
Estate recovery: After death, Medicaid can claim repayment from your estate — including your home — for the cost of care it paid for during your life.
The Medicaid trap
Spending down to qualify means losing the house, the savings, the inheritance — everything you worked for. Medicaid is the safety net of last resort, not a plan. Proper LTC planning (insurance or asset-based products) keeps you out of this trap entirely.
Want to know if your plan survives a real LTC event?
We'll model the "what if" — 3-year event, 5-year event, both spouses needing care — and tell you what your actual exposure is.
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More in Long Term Care
Sources
Medicare.gov · Medicaid.gov · ACL.gov
Educational content only. State Medicaid rules vary significantly. Consult a licensed elder-law attorney for your specific situation.