Healthcare & Long-Term Care
Medicare vs. Medicaid for long-term care
Updated April 1, 2026 · Editorial policy
Medicare and Medicaid sound similar but answer different questions. Medicare answers 'I'm 65 — how do I get health insurance?' Medicaid answers 'I'm out of money and I need long-term care — who pays?' Most families touch both at some point. Understanding the line between them is the first step in any long-term care plan.
What Medicare covers (and what it doesn't)
Medicare is federal health insurance for people 65+ and certain younger people with disabilities. It has four parts: A (hospital), B (medical), C (Medicare Advantage, a private alternative), and D (drugs).
Medicare PAYS for: short-term skilled nursing facility (SNF) care after a 3-day inpatient hospital stay (up to 100 days; days 21–100 have co-pays); home health care if you are 'homebound' and need skilled care; hospice care for terminal illness.
Medicare does NOT pay for: long-term custodial care (help with bathing, dressing, eating); assisted living room and board; adult day care; most home care that is not 'skilled.'
What Medicaid covers (and how to qualify)
Medicaid is a federal-state program for low-income people of any age. For seniors, the long-term care side of Medicaid is what matters.
Medicaid PAYS for: nursing home care (the largest payer in the U.S.); home and community-based services through state waivers (HCBS) — including some assisted living, adult day care, and in-home aide services; medical care not covered by Medicare.
To qualify: the senior must meet income limits (often around $2,901/month in 2025 for nursing home Medicaid in many states), asset limits (about $2,000 in countable assets), and a 'nursing home level of care' clinical standard. The home, one car, and personal items are usually exempt.
Medicaid has a 5-year look-back period and an estate recovery program. Both create planning opportunities and tripwires.
Side-by-side: long-term care
If you take only one thing from this page, take the table-style summary below.
- Eligibility: Medicare = age 65+ or disabled. Medicaid = low income + low assets + clinical need.
- Pays for nursing home: Medicare = up to 100 days of skilled care after hospital. Medicaid = unlimited custodial care if eligible.
- Pays for assisted living: Medicare = no. Medicaid = sometimes, via state HCBS waivers.
- Pays for home care: Medicare = only short-term skilled, 'homebound' rules. Medicaid = often yes, via HCBS waivers.
- Cost to enrollee: Medicare = premiums + co-pays. Medicaid = little or none.
- Choice of provider: Medicare = wide. Medicaid = limited to providers that accept Medicaid.
Dual eligibility
Many seniors qualify for both Medicare and Medicaid — they're called 'dual eligibles.' For dual eligibles, Medicare pays first and Medicaid fills in: co-pays, premiums, and the long-term care that Medicare won't touch. Special Needs Plans (D-SNPs) are Medicare Advantage plans designed for dual eligibles.
Sources
Sandwich is a directory and information site. This page is not legal, medical, or financial advice. For decisions that affect your family, consult a licensed professional in your state.
Frequently asked questions
Does Medicare ever pay for nursing home long-term care?
No. Medicare's nursing home coverage caps at 100 days per benefit period and only after a 3-day inpatient hospital stay — and only for skilled care, not custodial care.
Can I qualify for Medicaid if I own a house?
Usually yes, if you live there. The primary home is generally exempt up to a state equity limit while you live there. After death, the state may seek to recover from your estate.
What is the Medicaid 5-year look-back?
When you apply for Medicaid long-term care, the state looks back 5 years at any uncompensated asset transfers (gifts, transfers below market value). Transfers within that window can trigger a penalty period of ineligibility.
Can I be on Medicare and Medicaid at the same time?
Yes — that's called being dual-eligible. Medicare pays first; Medicaid fills in co-pays and premiums and pays for the long-term care that Medicare doesn't cover.
How do I apply for Medicaid long-term care?
Apply through your state Medicaid agency. Many families use an elder law attorney because the rules — especially the look-back, estate recovery, and spousal impoverishment protections — vary by state and are easy to get wrong.