[Last updated October 14, 2025]
When a parent or spouse starts to need the extra help provided by senior care, many families assume Medicare or Medicare Advantage will cover the costs. Unfortunately, that’s not the case, especially when it comes to assisted living, memory care, or long-term nursing home stays. In this article, we’ll help you understand what Medicare Advantage does and doesn’t cover to help you avoid financial surprises and plan more effectively.
What is Medicare Advantage?
Medicare Advantage (Part C) is an alternative to original Medicare. It is offered through Medicare-approved private insurance companies that must provide specific coverages. Part C plans combine hospital coverage (Part A) and medical coverage (Part B) into a single plan, and many also include prescription drug coverage (Part D) and other benefits.
Key differences from original Medicare
| Feature | Medicare Advantage | Original Medicare |
| Coverage structure | All-in-one plan through private insurer | Separate Parts A, B, and D |
| Network restrictions | Usually requires using in-network providers | Can generally see any Medicare provider in the country |
| Extra benefits | Often includes dental, vision, and hearing coverage | Individuals typically must pay out of pocket |
| Out-of-pocket maximum | Annual cap on costs | No limit (unless you buy Medigap) |
Many seniors choose Medicare Advantage because of low premiums (although they’ll still pay the Part B premium) and additional benefits. However, when it comes to senior care, the coverage rules remain largely the same as those of original Medicare, with some notable differences that we’ll explore below.
What senior care is covered?
Medicare Advantage covers medically necessary care, but the emphasis is on “medically necessary.” Here’s what that means in practice:
Skilled nursing facility care (short-term only)
Medicare Advantage will cover short-term stays in a skilled nursing facility, but only under specific conditions:
- You must first have a qualifying hospital stay of at least three days (although some plans waive this requirement).
- The skilled nursing care must be medically necessary.
- Coverage is limited to 100 days per benefit period.
- Days 1 to 20 are typically fully covered, although copay structures can vary by plan.
- Days 21 to 100 require you to make copayments (which can be substantial).
A familiar story: Your father has hip replacement surgery and needs rehabilitation. Medicare Advantage will cover his stay at a skilled nursing facility for physical therapy and medical monitoring. Once he can manage daily activities independently, coverage will end, even if he’s not ready to live alone. That’s when many families face a difficult choice: Can he safely return home, or does he need assisted living that the family will have to pay for privately?
Home health care (skilled services only)
Medicare Advantage covers home health care when:
- A doctor certifies it’s medically necessary.
- You need skilled nursing care or therapy (physical, occupational, or speech).
- You’re homebound (meaning that leaving home requires considerable effort).
- The provider is Medicare-certified.
What’s covered:
- Part-time skilled nursing care.
- Physical, occupational, and speech therapy.
- Medical social services.
- Home health aide services for assistance with personal care (only if your doctor prescribes it as medically necessary while you’re also receiving skilled nursing or physical, occupational, or speech therapy through home health care; not as stand-alone personal care).
What’s not covered:
- Help with bathing, dressing, or eating (custodial care) when that’s all you need (although it may be available for a short time under the circumstances described above).
- Meal preparation.
- Homemaker services.
- 24-hour care at home.
A familiar story: After your mother’s stroke, Medicare Advantage pays for a physical therapist to visit three times a week and a nurse to check her vital signs and manage medications. A home health aide can help her shower on the days the therapist comes. But once she completes therapy and no longer needs skilled nursing visits, all coverage stops, even though she still can’t prepare meals safely or remember to take her medications. At that point, families typically need to hire private caregivers or consider other living arrangements.
Hospice care
Medicare Advantage covers hospice care for terminally ill patients with a life expectancy of six months or less. Coverage includes:
- Pain and symptom management.
- Medical equipment and supplies.
- Short-term respite care for caregivers.
- Counseling and support services.
When you choose hospice, your care is covered under original Medicare, even if you’re enrolled in a Medicare Advantage plan. Your plan may still cover unrelated care (such as vision or dental), but hospice care itself is covered directly through Medicare.
What senior care is not covered?
Many families face difficult surprises when it comes to what is not covered by Medicare Advantage. Note that the costs listed below will vary substantially by state and are the responsibility of the individual or their family.
Assisted living or memory care
Assisted living and stand-alone memory care facilities provide help with daily activities but aren’t medical settings. You’ll pay out of pocket or have to find other funding sources for the services provided there, including:
- Room and board.
- Assistance with bathing, dressing, and eating.
- Medication reminders.
- Social activities and supervision.
Average national costs: $70,800 per year.
A familiar story: Your mom is 82 and has been living independently, but she’s started forgetting to eat regular meals and sometimes leaves the stove on. She doesn’t need medical care. She needs someone to ensure she takes her pills, eats nutritious meals, and stays safe. That’s precisely what assisted living provides, but Medicare and Medicare Advantage won’t cover it.
Long-term nursing home care
Once your skilled nursing benefit runs out after 100 days (or if you need custodial care rather than skilled care), Medicare Advantage won’t cover long-term nursing home costs. Most families pay privately or, if they’re eligible, use Medicaid to pay for this type of care.
Average national costs: $111,325 to $127,750 per year for a semiprivate or private room in a nursing home.
Custodial care and ADL assistance
Medicare Advantage won’t pay for nonmedical help with activities of daily living (ADLs) and other daily tasks, such as:
- Bathing and grooming.
- Getting dressed.
- Preparing meals.
- Managing reminders (not administration).
- Light housekeeping.
- Transportation to appointments (if offered by the provider).
Average national costs: $75,504 per year for homemaker services and $77,792 for home health aide services for 44 hours a week (the costs will vary widely based on the number of hours of care needed).
Additional benefits that some Medicare Advantage plans may include
Here’s where Medicare Advantage can offer more than original Medicare. Many plans include supplemental benefits that can help with some costs for seniors.
Common additional benefits:
- Transportation to medical appointments (and sometimes grocery stores).
- Telehealth services.
- Fitness programs (gym memberships, exercise classes).
- Dental, vision, and hearing coverage.
- Over-the-counter medication allowances.
- Adult day health care services.
These benefits vary dramatically by plan and location. One Medicare Advantage plan may offer robust transportation and fitness benefits, while another may offer almost nothing beyond basic Medicare coverage. Always review the evidence of coverage document for your specific plan.
Some plans now offer limited help with daily activities through Special Supplemental Benefits for the Chronically Ill (SSBCI), available only to qualifying members with certain chronic conditions. These are newer offerings and not available in all plans.
Planning for uncovered care costs
| Care type | Medicare Advantage coverage | Payment options |
| Skilled nursing (first 100 days) | Yes, with conditions | Personal savings for Medicare Advantage copays |
| Assisted living | No | Personal savings, long-term care insurance |
| Memory care | No | Personal savings, long-term care insurance |
| Long-term nursing home | No | Personal savings, long-term care insurance |
| Home custodial care | No | Personal savings, long-term care insurance |
In summary, Medicare Advantage covers recovery and skilled medical care but not the ongoing daily assistance many seniors need. If you’re planning for a parent’s care or your own future needs:
- Consider long-term care insurance.
- Investigate Medicaid eligibility rules in your state.
- Have honest conversations about care preferences and finances before a crisis occurs.
Medicaid is a state-administered service, so if you’re eligible, your benefits can vary substantially. Exploring Medicaid is a worthwhile investment of time as a solution for several uncovered care costs.
Conversations about senior care aren’t easy, but understanding existing coverage gaps now can help you make better decisions and avoid financial hardship later.
