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What Medicare Does and Does Not Pay For

Medicare covers short skilled nursing stays, home health and hospice. It does not pay for assisted living or custodial care, in any state.

HomeCosts & PayingWhat Medicare Does and Does Not Pay For
Short answer

Medicare does not pay for assisted living, memory care, or long-term custodial care anywhere in the country. It covers limited skilled nursing facility stays after a qualifying hospital admission, intermittent skilled home health, and hospice.

What Medicare covers

  • Skilled nursing facility care after a qualifying inpatient hospital stay, for a limited period, when skilled care is needed daily. This is rehabilitation, not long-term placement.
  • Home health that is intermittent and skilled — nursing visits, physical, occupational or speech therapy. Not a caregiver who stays with your parent.
  • Hospice — the hospice team, medications related to the terminal diagnosis, and equipment. Not room and board in a facility.
The observation status trap. A Medicare skilled nursing benefit requires a qualifying inpatient hospital admission. Time spent under “observation status” does not count, even if your parent slept two nights in a hospital bed. Ask the hospital directly whether your parent is admitted as an inpatient or under observation, and ask in writing.
What senior care costs. New York's CareScout median is $7,110/month for assisted living and $16,729/month for a private nursing home room. Read the full explanation →

Questions families ask

What does Medicare's skilled nursing facility benefit actually require in terms of a prior hospital stay?

Medicare's skilled nursing facility benefit generally requires that the patient first have a qualifying inpatient hospital stay of at least 3 days before Medicare will cover a subsequent skilled nursing facility stay, and only time spent formally admitted as an inpatient counts toward that requirement, not time spent under observation status. This is a critical distinction for Long Island families navigating a hospital discharge, since a stay that looks identical from the patient's bed can be billed either way.

Does NYU Langone have Long Island hospital locations, and what should I know about discharge planning there?

Yes. NYU Langone operates two Long Island hospital campuses: NYU Langone Hospital-Long Island, a 591-bed medical center at 259 First Street in Mineola, formerly Winthrop-University Hospital, renamed in November 2020, home to Nassau County's only adult Level 1 Trauma Center and the NYU Grossman Long Island School of Medicine; and NYU Langone Hospital-Suffolk. As with any hospital system, discharge planning is coordinated by staff at the specific campus where a patient is admitted.

My parent just fell and is in the hospital - what's the first call I should make?

For families in Nassau or Suffolk County, the Office for the Aging in your parent's home county is a good first call - Nassau County Office for the Aging at 516-227-8900, or Suffolk County Office for the Aging at 631-853-8200. Both function as the local NY Connects access point, a free service that helps families understand care options, eligibility, and next steps after a hospital event, without any cost or obligation.

My father was just diagnosed with dementia - what should we be planning for on Long Island?

A new dementia diagnosis typically means starting to think about progressively higher levels of support: from in-home caregiving, to a Special Needs Assisted Living Residence (SNALR)-certified memory care community, to eventually possibly a nursing home. The Nassau (516-227-8900) or Suffolk (631-853-8200) County Office for the Aging can connect families to local resources and benefits counseling as needs evolve, and it's worth confirming any Long Island community marketing memory care actually holds SNALR certification via NYS Health Profiles.

I'm exhausted from caring for my spouse or parent - what support exists for caregivers on Long Island?

Both the Nassau County Office for the Aging (516-227-8900) and Suffolk County Office for the Aging (631-853-8200) serve as local NY Connects access points and can help connect exhausted family caregivers to respite options, including adult day health care, at a New York State median of $144 per day, and in-home caregiver support, at a state median of $35 per hour, which can relieve some of the daily burden without requiring a full residential placement.

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