If You Have Medicare, Will It Really Cover Long-Term Care?

By Steve Kim · Published: August 17, 2026 · Updated: August 25, 2026

A basic guide to Medicare and long-term care for New Jersey residents aged 65 and older

“I have Medicare, so I don’t need to worry about nursing home costs — right?” A lot of people think exactly this. In reality, it does not work that way. In this two-part series, I want to lay out clearly how much Medicare actually helps with long-term care (nursing home) costs, and what you need to know.

What is Medicare?

Medicare is the federal health insurance program that most people are automatically enrolled in at age 65. It helps with a wide range of medical costs — hospital bills, physician visits, prescription drugs. But there is something many people do not realize: when it comes to long-term care, the limits are very significant.

The conditions under which Medicare covers a nursing home

For Medicare to help with the cost of a Skilled Nursing Facility (SNF), two conditions must both be met.

First, you must have been formally admitted to a hospital for at least 3 days. A stay for testing or emergency observation does not count. If the hospital processed your stay as an “Observation Stay,” you do not qualify either — so while you are in the hospital, make sure to confirm with your doctor whether you have been formally admitted.

Second, you need a physician’s determination that you require nursing facility care for a condition directly related to that hospital stay.

How much does it actually help?

If both conditions are met, Medicare Part A pays as follows:

Days 1–20: fully covered (you pay nothing)
Days 21–100: about $217 per day out of pocket (2026 figure)
Day 101 onward: no Medicare coverage — you pay the full cost

In other words, Medicare helps for a maximum of 100 days, and after that it does not help with the cost at all. For someone with Alzheimer’s or recovering from a stroke, who may need care for years, Medicare amounts to nothing more than temporary help at the very beginning.

Long-term care hospital costs in New Jersey run 0 to 0 a day, or ,000 to ,000 a month. Medicare covers a limited period only, usually up to 100 days if you qualify, leaving thousands per month to pay yourself.

What does a nursing home cost in New Jersey?

New Jersey is one of the most expensive states in the country for long-term care.

Skilled nursing facility, private room: $12,775 per month on average (about $153,000 a year, 2025 figures)
Assisted living: $6,500 per month on average
In-home care aide (based on 40 hours a week): $6,200 per month on average

Assuming an average of three years of care, the skilled nursing facility cost alone comes to roughly $460,000. When you consider that Medicare fully covers only 20 days, it becomes clear that the rest is something you have to prepare for yourself.

Can you receive care at home instead?

Yes, you can. When a doctor has ordered it, visits from a skilled nurse or a physical therapist are covered by Medicare. However, the following are not included:

Basic household help such as meal preparation and cleaning
Bathing assistance on its own, without a medical purpose
A 24-hour personal caregiver

To receive care at home, a doctor’s order is required, and you must be confirmed as homebound.

The bottom line: start planning now

Medicare on its own is not enough to carry the full cost of long-term care. If you are 65 or older and living in New Jersey, it is essential to look ahead at whether you might qualify for Medicaid, at long-term care insurance, and at asset protection planning. In the next installment, I will go through specific ways to address these costs for people who do have assets.

This article is provided for general informational purposes. For decisions that fit your own circumstances, please consult a Medicare specialist or an elder law attorney.