Medicare does not pay for long-term custodial care like that received in nursing homes. Such care can cost over $160,000 per year in New York. While Medicare helps with medical costs, 7 in 10 seniors will require long-term care assistance that Medicare does not cover. Medicaid may pay for long-term care for those with limited assets who qualify through a spend-down process. Planning is needed to qualify for Medicaid assistance with long-term care costs that Medicare does not cover.

1. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 1
“For many, the solution is Medicaid. This program does pay
for living assistance if you can qualify, but it is only
available to people with limited assets. Many people obtain
eligibility through a process called a spend down.”
DOES MEDICARE PAY FOR
LONG-TERM CARE IN NEW
YORK?
MARK S. EGHRARI
NEW YORK ESTATE PLANNING ATTORNEY

2. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 2
When you pay FICA or self-employment taxes while you are working, it can seem
as though your compensation is being reduced for no particular reason. In fact,
these taxes do provide you with benefits when you attain senior citizen status.
You earn retirement credits when you pay these taxes, you can earn up to four
credits per year. The requirements are very modest, so most people who work for
any length of time during a calendar year do accumulate the maximum four
credits. Once you have accrued a total of at least 40 credits during your lifetime,
you will qualify for Medicare and Social Security.
At the present time, the eligibility age for Medicare health insurance is 65. This
program is divided up into multiple different parts, and there are out-of-pocket

3. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 3
expenses, so you should budget for these costs when you are devising a
retirement budget.
Medicare Part A is the segment of the program that pays for inpatient
hospitalization, and there are no premiums for this coverage, but there is a
deductible per benefit period, and there can be co-payments for extended
hospital stays.
You do have to pay a monthly
premium for Medicare Part B,
which is the portion of the
program that pays for visits to
doctors and outpatient care. The
exact amount of the monthly
premium depends upon your
income level, but most people
are paying around $105 per
month at the present time.
There are also deductibles, and there are co-payments.
Part C allows you to combine your Medicare coverage with private insurance to
cover some of the gaps, and Medicare Part D is the prescription drug component.
There are co-payments, premiums, and deductibles for this coverage as well.
As you can see, there are reasonably significant costs that you have to pick up on
your own, even if you qualify for Medicare as a senior citizen, so you should keep
this in mind when you are looking ahead toward the future.

4. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 4
LONG-TERM CARE
Since Medicare is designed to help
seniors address medical costs that they
will invariably face, you would assume
that it is set up to assist with long-term
care expenses. The United States
Department of Health and Human
Services states that seven out of every
10 seniors will someday need living
assistance, so this is a likelihood for
most of us.
Whether it makes sense or not,
Medicare does not pay for long-term
care, because it is considered to be
custodial care. The program will pay
for convalescent care after an injury or
illness, but it does not pay for custodial care, which is the type of care that you
would receive in a nursing home or assisted living community.

5. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 5
This is a very significant fact of life, because it is not easy to pay for long-term
care out-of-pocket without losing all or most of what you intended to leave to
your loved ones after you are gone. We practice law on Long Island. Long-term
care costs are high everywhere, but assisted living facilities are particularly
expensive in our area.
Genworth Financial has put the subject under the microscope. They have found
that the median annual charge for a private room in a Long Island nursing home
is $162,425, and they expect costs to rise by three percent per year over the next
five years.

6. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 6
The average length of stay is approximately 2 years and three months according
to a government agency, and 10 percent of nursing home residents reside in the
facilities for a minimum of five years.
CONCLUSION
To sum things up, we can highlight three important facts: most seniors will need
long-term care eventually, it is very
expensive, and Medicare will not pay
for it.
For many, the solution is Medicaid.
This program does pay for living
assistance if you can qualify, but it is
only available to people with limited
assets. Many people obtain eligibility
through a process called a spend
down. They give assets to their loved
ones, but there are strict rules with
regard to the timing, so you have to
act well in advance if you want to
position yourself in the ideal manner.
Contact an elder law attorney if you
would like to discuss nursing home asset protection strategies with a licensed
professional.

7. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 7
REFERENCES
U.S. Department of Health and Human Services
http://longtermcare.gov
Genworth Financial
https://www.genworth.com/corporate/about-genworth/industry-expertise/cost-
of-care.html
Medicare
https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-
glance.html

8. Does Medicare Pay for Long-Term Carein New York? www.myestateplan.com 8
About the Author
Mark S. Eghrari
Mark S. Eghrari is an attorney in private practice in Smithtown, New
York. He has been in practice since 1988. Mark S. Eghrari provides
extensive estate and tax planning services to individuals and
businesses. Mr. Eghrari’s primary focus is helping clients avoid
probate, minimize or eliminate Federal and State Estate taxes and
protect their assets from the high cost of nursing care, if they become
ill. Mr. Eghrari’s expertise is in providing unique and innovative
estate planning solutions that create a secure future for his clients and their loved ones. Mr.
Eghrari is a member of the American Bar Association and New York State Bar Association as
well as the National Academy of Elder Law Attorneys and the American Academy of Estate
Planning Attorneys.
Mr. Eghrari completed his undergraduate work at Lafayette College in Easton, Pennsylvania
and received his MBA in banking and finance from Hofstra University on Long Island. He
earned his Juris Doctorate from the Hofstra University School of Law, where he was a member
of the Law Review. While in law school, Mr. Eghrari gained practical experience in the
corporate tax department of Citicorp in New York city.
Mark S. Eghrari and Associates PLLC
www.myestateplan.com
50 Karl Avenue, Suite 202
Smithtown, NY 11787
Phone: (631) 265-0599
Fax: (631) 265-0754