If you’re like most of my Medicare clients, coverage is pretty simple:
- You see your doctor for regular checkups or when you have a problem
- You have regular screening tests, such as for cancer, diabetes, and heart disease
- Occasionally, you may have minor day surgery or an outpatient procedure
You’ll probably pay a deductible, copayment, or co-insurance.
But what if something serious happens? Say, an accident or illness that requires a hospital stay plus time in a skilled nursing facility and a long recovery at home.
As you get older, you’re more likely to have a serious medical situation which requires some type of long-term care of some kind.
According to U.S. Government statistics, slightly more than one in four adults over age 65 are hospitalized each year. Of those, 25% will be discharged to a skilled nursing facility. The rest will go home but may need both medical and non-medical home care.
Before that happens to you, let’s look at how Medicare or other insurance covers hospitalization, rehab stays, and home care. A little planning up front can help you be prepared.
Step 1: Hospital Stays
Medicare Part A covers medical costs directly related to your hospital stay (semi-private room, hospital staff, meals, medical supplies, etc.).
You must be formally admitted by a doctor for Part A coverage to kick in. Just being kept for observation isn’t enough.
Here’s how Medicare Part A coverage works:
- For the first 60 days: Medicare covers most costs after you meet the Part A deductible ($1,676 for 2025).
- Days 61–90: you pay $419/day and Medicare picks up the rest.
- After 90 days: You can either pay all costs or pay use “reserve days” (which can only be used once in your lifetime) for $838/day.
If you’re in the hospital more than 150 days, you pay all hospital costs.
Your hospital stay is also a key requirement for the next phase of care.
Step 2: Skilled Nursing Facility (SNF)
If you spend at least three consecutive inpatient days in the hospital, Medicare Part A may cover a follow-up stay in a Skilled Nursing Facility.
To qualify, your doctor must recommend continued care or rehab. Care must be considered “necessary” and be provided by licensed medical professionals. This could include:
- Physical or occupational therapy
- IV medications or wound care
- Post-surgical rehab
If you meet these conditions, Medicare Part A covers:
- All costs for the first 20 days
- Days 21–100: You pay coinsurance (currently $204/day)
- After 100 days, you pay all costs
Medicare does not cover long-term custodial care like bathing or dressing, unless it’s part of skilled medical treatment.
Step 3: Home Health Care
Once you’re stable enough to return home, Medicare may continue to cover your care if it’s part of a doctor-ordered treatment plan.
Covered services may include:
- Skilled nursing (such as medication management)
- Physical, occupational, or speech therapy
- Medical social services
- Part-time home health aide support (if you’re also getting skilled care)
Medicare does not cover 24/7 home care, meal delivery, or full-time aides unless you’re receiving ongoing skilled services.
You must also be homebound, which means it’s difficult to leave your home without help.
Step 4: When You No Longer Need Skilled Medical Care
Medicare coverage ends when you don’t need additional medical care.
However, you may still need help with daily activities—like cooking, bathing, or getting dressed.
Medicare doesn’t pay for:
- Long-term help with personal care
- Non-medical home aides (if not tied to skilled care)
- Ongoing housekeeping or meal services
Personal care can be expensive if you have to pay for it out of pocket.
What About Non-Medical Care?
Medicare only covers short-term care after an illness or injury. It’s smart to plan ahead, especially for the things Medicare doesn’t cover.
Family members and friends can help, but what if they don’t live close, get burned out, or can’t provide the help you need?
Long-term care insurance can help pay for:
- Custodial care at home
- Assisted living
- Extended nursing home stays
The best time to buy long-term care insurance is in your 50s or early 60s—before health problems make it harder to qualify or drive up the price.
Be Prepared
Medicare provides essential coverage for hospital stays, rehab, and some home care. But it doesn’t cover most personal care, either at home or in assisted living.
A little preparation can help protect your finances and give you peace of mind.
Your Medicare advisor is your best resource before, during and after any hospital stay. They can also give you guidance for long-term care coverage.
Do you have questions about hospitalization, recovery, and home care? I’m here to help.
Call me at (832) 773-7981, email me at scott.goodell@ghstx.com, or use my contact form.