Centuries ago, everyone believed that the earth was flat. It took decades of daring exploration to convince people otherwise.
We realize that the analogy seems like a stretch, but today a discouraging percentage of seniors believe that Medicare will cover their long-term care expenses. Sadly, the truth is just the opposite – but it might take bitter experience and a financial crisis to convince these wishful thinkers that they’re wrong.
This week on the Blog, we’re focusing on issues related to long-term care, along with a closely-related topic, the “Medicare/Medicaid” confusion. In researching this important subject, we discovered this article from the Daily Overview website in which reporter Silas Redmond explores the fact that – as vitally important as the program is – Medicare fails to cover some of the most costly and necessary medical issues seniors will face. Chief among them is long-term care.
Nearly Half of Seniors Woefully Misinformed About Medicare
Just how widespread is the misinformation concerning Medicare and long-term care? Sad to report, the level of ignorance is depressingly high.
In a Seattle Times article last summer on a related topic, we included this quote, referring to research by health policy organization KFF. Reporter Mark Miller writes, “KFF polling shows that 23 percent of all adults — and 45 percent of those age 65 or older (emphasis added) — incorrectly believe that Medicare will cover their time in a nursing home if they have a long-term illness or disability.”
Miller goes on to relate a discouraging corollary: “Fewer than half of adults said they’ve talked seriously with loved ones about how they would obtain or pay for long-term care. And among near-retirement individuals, just 28 percent say they have set aside money for it.”
In other words, millions of seniors remain both uninformed and in denial about the potentially catastrophic cost of long-term care.
Medicare Coverage “Leaves a Gaping Hole” for Seniors
With that as background, let’s dive into the Daily Overview article by Silas Redmond. He begins, “For all its importance to older Americans, Medicare still leaves a gaping hole in coverage that can upend even careful retirement plans. The single biggest blind spot is long-term care, the ongoing help with daily activities that millions of seniors eventually need but wrongly assume their health insurance will handle.”
Tragically, as Redmond observes, this assumption comes with an insurmountable cost. “When that assumption collides with reality,” says Redmond, “families discover that the most punishing bills in retirement are often the ones Medicare never intended to pay.”
Long-Term Coverage Gap Affects All Aspects of Life
The article notes perceptively that the long-term care coverage gap affects every aspect of life for seniors and families – something Rajiv talks about frequently on the radio and in person.
Redmond writes, “I see this gap reshaping how households think about work, savings, and even where they live in later life.” He adds that, for today’s seniors, developing a deeper understanding of exactly what Medicare will and will not cover and precisely what your benefits are is absolutely essential.
“The stakes are not abstract,” says Redmond: “they show up in five-figure annual invoices from nursing homes, assisted living communities, and home care agencies that can drain a lifetime of savings in just a few years.”
Medicare Was Never Designed as Long-Term Care Insurance
“While Medicare is an incredibly valuable program that protects older adults from many hospital and doctor bills,” says Redmond, “it was never designed to function as full long-term care insurance.” Instead, Medicare focuses on shorter-term medical needs – inpatient stays, surgeries, and physician visits. This, the article acknowledges, “leaves out entire categories of support that shape financial security later in life.”
He cites this CBS News report from mid-2025 that spotlights key medical services Medicare does not cover but which many retirees assume are standard, including dental care, vision care, and hearing care.
“At the center of that list is custodial care, the routine help with bathing, dressing, eating, and other daily tasks that becomes necessary as people age or live with chronic conditions,” Redmond notes. “Analysts repeatedly flag that this is not a minor omission but a structural gap that can undermine financial security later in life, even for households that did everything ‘right’ in saving and planning.”
Redmond’s loud note of caution sounds like Rajiv: it’s essential, he asserts, that retirees “plan around this [coverage] hole rather than discovering it only when a crisis hits.”
Long-Term Care vs. Medical Treatment – Where Confusion Begins
Redmond’s insightful article notes that this confusion about what Medicare does and doesn’t cover often starts with nursing homes, “where the line between medical treatment and long-term living arrangements can blur.” (We lack the space to cover these issues in greater depth, so we encourage you to check out the original article.)
Basically, he explains, Medicare coverage in skilled nursing centers is not open-ended, but instead is tied to specific medical criteria and proscribed benefit periods. “When a patient meets the rules,” says the article, “Medicare Part A can pay in full for a limited stretch of skilled care, but once that window closes, the program steps back and the bill shifts to the patient.”
Senior Advocacy Organizations Try to Inform the Public
Many advocacy groups are attempting to ensure that seniors and their families know what to expect. One example comes from the National Council on Aging (NCOA).
In their explanatory posting about Medicare and nursing homes, Redmond explains, the NCOA explains that, after 20 days in a nursing facility, patients will start paying a daily coinsurance amount, even if Medicare is still involved. The NCOA further notes that Medicare Part A can cover up to 100 days of skilled nursing care per benefit period.
“But beyond that,” Redmond warns, “you pay all costs, a pivot that can instantly turn a medical recovery into a financial emergency.”
Skilled Nursing Not the Same as Long-Term Assistive Care
Redmond’s article goes on to explain that seniors need to understand how skilled nursing differs from long-term assistive care. Medicare guidelines stipulate that skilled nursing care must follow a 3-day inpatient hospital stay and be medically necessary in order for Medicare to cover the cost.
“That is very different from an open-ended stay in a facility where the primary need is help with daily activities rather than ongoing medical treatment,” Redmond writes. “Federal rules make the distinction explicit: Medicare does not pay for long-term care.”
This creates a huge disconnect, since roughly 60 percent of us will eventually need help with everyday activities, often for extended periods. “Medicare’s role is limited to short-term skilled services like physical therapy after suffering an injury,” Redmond writes, a fact which he calls “the heart of the problem.”
Medicare Confusion Also Affects Other Types of Long-Term Care
In his analysis, Redmond notes that the lack of consumer awareness regarding Medicare and long-term care isn’t limited to traditional nursing homes. It also affects assisted living and home health care, neither of which is paid for by Medicare.
“Assisted living communities market themselves as a middle ground between full institutional care and aging in place,” Redmond writes, “but they are not treated as medical facilities under federal rules.” In the agency’s guidance on Medicare and assisted living, the National Council on Aging says that Medicare does not cover assisted living because the cost is not considered medically necessary – this despite the fact that staff members in these facilities routinely help residents with both daily tasks and medication management.
Home-based support falls into a similar coverage gap. Part A may provide some coverage for in-home services that are part of a broader medically-necessary care plan, but “once the skilled component ends, you pay all costs for ongoing custodial help,” says Redmond. Families are generally left to manage these expenses on their own.
“Quiet Caregiving Crisis” is Having a Multi-Generational Impact
Redmond quotes research from the University of Pennsylvania’s Leonard Davis Institute which warns that unmet health care costs, especially for long-term care, represent a direct threat to the economic security of American families. Rising medical costs of all kinds make it more and more difficult for Americans to save for their own long-term care needs as they age.
A national caregiving survey from AARP echoes this concern, urging that Medicare rules ought to be amended to include long term care coverage. The advocacy organization warns that skyrocketing costs combined with lack of coverage and a declining workforce among caregivers have created “a quiet caregiving crisis that plays out in unpaid labor, lost wages, and depleted savings across generations.”
Realistically, however, it’s hard for us to envision that type of change to Medicare happening any time soon. That leaves families scrambling to come up with their own answers.
Retirees Fill the Coverage Gap with a “Patchwork of Solutions”
Faced with the need to plan for the high cost of long-term care, older adults are “piecing together a patchwork of solutions,” Redmond writes.
Some who can afford it have purchased private long-term care insurance. Others are relying on home equity, either through outright sale of their home or a reverse mortgage. For many, family support is essential, either financially or as unpaid caregivers.
Then, once assets are depleted or otherwise sheltered, Medicaid provides the safety net.
Regardless of the financial specifics, legal and financial experts like Rajiv Nagaich continue to label uncovered long-term care costs as the biggest single financial threat for most retirees. These experts argue that long-term care planning must be a top priority for Americans as they prepare for retirement, every bit as important – if not more so – as issues like Social Security timing and investment allocation.
(This Blog article published in mid-2025 lists some of the ways seniors are paying for long-term care.)
Why Seniors and Their Families Can’t Wait for Uncle Sam
Redmond concludes his article in the Daily Overview with the sober assessment that the long-term care coverage gap remains firmly in place, and is unlikely to change any time soon. As a result, long-term care costs “sit at the top of the list of expenses that can derail retirement.”
“Policy analysts and caregiving organizations are increasingly vocal about the need for reform,” says Redmond, “but they are also blunt that families cannot wait for Washington to solve the problem.” Medicare, he writes, still does not cover what experts term “the most expensive part of aging.”
The bottom line is clear. “Until that changes,” says Redmond, “the burden of planning for long-term care will remain on individuals and their families, who must navigate a system that covers hospital stays and surgeries but leaves the slow, costly work of daily care largely to them.”
Rajiv Nagaich – Your Retirement Planning Coach and Guide
Rajiv Nagaich’s newest program on PBS, called The Path to Happily Ever After, is bringing Rajiv’s powerful message to Americans from coast to coast. This engaging and challenging PBS show and the accompanying video and workbook are prompting thousands to take a fresh look at the type of planning that will help them succeed in retirement.
What about you?
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You’ve heard Rajiv say it repeatedly: 70 percent of retirement plans will fail. If you know someone whose retirement turned into a nightmare when they were forced into a nursing home, went broke paying for care, or became a burden to their families – and you want to make sure it doesn’t happen to you – then these materials are your key to retirement success.
Through stories, examples, and personal insights, Rajiv takes us along on his journey of expanding awareness of a problem that few are willing to talk about – yet it’s one that results in millions of Americans sleepwalking their way into their worst nightmares about aging. Rajiv lays bare the shortcomings of traditional retirement planning advice, exposes the biases many professionals have about what is best for older adults, and much more.
Rajiv then offers a solution: LifePlanning, his groundbreaking approach to retirement planning. Rajiv explains the essential planning steps and, most importantly, how to develop the framework for these elements to work in concert toward your most deeply held retirement goals.
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(originally reported at https://thedailyoverview.com)
The post Medicare Won’t Cover the Biggest Expense Seniors Will Face appeared first on Home.
