Medicare Advantage and Long-Term Care: 9 Things Families Should Review Before Choosing a 2027 Plan

Choosing health coverage for an older adult can feel especially complicated when long-term care is already part of the conversation. Your parent may be recovering from a hospital stay, needing more help at home, living with dementia, or preparing to move into a care community.

At the same time, Medicare Advantage plans can change from one year to the next. A doctor may leave the network. A medication may move to a different cost tier. Copayments, prior authorization rules, or supplemental benefits may also change.

If your family is reviewing Medicare Advantage and long-term care needs for 2027, you do not have to become a Medicare expert overnight. However, it is important to understand what these plans may cover, what they generally do not cover, and which details could affect your loved one’s care.

Here are nine areas to review before choosing a 2027 plan.

Quick Answer: Does Medicare Advantage Cover Long-Term Care?

Medicare Advantage generally does not pay for ongoing non-medical long-term care, sometimes called custodial care. This includes extended help with bathing, dressing, eating, toileting, supervision, or other daily activities when those are the only services a person needs.

However, a Medicare Advantage plan can still affect important parts of a person’s care. Depending on the plan and eligibility requirements, it may cover short-term skilled nursing care, home health services, rehabilitation, medical equipment, hospital care, physician services, and prescription medications. Some plans also offer limited supplemental benefits, such as transportation, meals after a hospital stay, or certain in-home support.

The key is to avoid confusing covered medical services with comprehensive long-term care coverage. A plan may help with specific healthcare needs without paying for the ongoing cost of living in assisted living, memory care, or a nursing home.

Because Medicare Advantage long-term care coverage is limited, families should also consider how ongoing personal care, supervision, housing, and other non-medical support will be paid for.

What Is the Difference Between Medical Care and Long-Term Care?

Medicare is primarily health insurance. It helps pay for medically necessary services used to diagnose, treat, or manage an illness or injury.

Long-term care often focuses on helping someone manage everyday life over an extended period. It may include help with bathing, dressing, eating, walking, toileting, meals, housekeeping, medication reminders, safety supervision, or dementia-related needs. It may be provided at home or in assisted living, memory care, a residential care home, or a nursing home.

The official Medicare & You 2027 handbook explains that Medicare and most health insurance do not pay for non-medical long-term care, including personal assistance with everyday activities.

Medicare may still cover eligible medical services a person receives while living at home or in a care community. For a complete explanation, read What Does Medicare Cover for Long-Term Care? With that distinction in mind, here are nine areas to review before choosing a 2027 Medicare Advantage plan.

1. Read the Annual Notice of Change

If your loved one already has a Medicare Advantage plan, do not assume that the coverage will remain the same in 2027.

The plan’s Annual Notice of Change explains changes that will take effect in January. These may involve benefits, costs, the service area, prescription coverage, or provider networks. Plans provide this notice by September 30.

The Evidence of Coverage contains more detailed information about what the plan covers, how services are accessed, and what the member may pay. According to Medicare, members should receive a notice or printed copy by October 15.

When reviewing these documents, look for changes involving:

• Monthly premiums and deductibles
• Copayments and coinsurance
• Annual out-of-pocket limits
• Doctors, hospitals, and other providers
• Skilled nursing facility costs
• Home health and rehabilitation services
• Prior authorization requirements
• Prescription drug coverage
• Supplemental benefits

Advertisements and benefit summaries rarely explain every restriction or cost. If something is unclear, call the plan and request an explanation in writing.

2. Compare the Total Cost, Not Just the Premium

A plan with a low or zero-dollar premium is not necessarily the least expensive option for someone who needs frequent medical care.

Look beyond the premium and compare:

• Medical and prescription drug deductibles
• Primary care and specialist copayments
• Hospital costs
• Skilled nursing facility copayments
• Rehabilitation and therapy costs
• Durable medical equipment cost sharing
• In-network and out-of-network costs
• The annual maximum out-of-pocket limit

The annual out-of-pocket limit applies to covered Part A and Part B services. Premiums, prescription drug costs, and non-covered services generally do not count toward that medical limit. Consider the care your loved one actually uses. A slightly higher premium could be worthwhile if the plan charges less for the services they are most likely to need.

3. Confirm That Important Providers Are In-Network

Provider networks can strongly affect both access to care and out-of-pocket costs.

Check the plan’s network for:

• The person’s primary care physician
• Important specialists
• Preferred hospitals
• Skilled nursing facilities
• Rehabilitation providers
• Home health agencies
• Medical equipment suppliers
• Pharmacies

Do not ask only whether a provider “accepts Medicare.” Ask whether the provider participates in the exact Medicare Advantage plan being considered for 2027.

Confirm participation with both the plan and the provider because online directories can change. Save the date, representative’s name, and any reference number.

This step is especially important if your loved one already lives in or may enter a nursing home, assisted living community, or memory care community.

A care community may accept someone as a resident even when some clinicians, suppliers, or pharmacies serving it are outside the resident’s plan network. Ask which providers commonly serve residents, then verify them with the plan.

4. Review Skilled Nursing Facility Coverage

Medicare-covered skilled nursing facility care is intended for short-term skilled care or rehabilitation. It is not the same as permanent nursing home residence or ongoing custodial care.

Someone may qualify when daily skilled nursing or therapy is medically necessary and all applicable coverage requirements are met. Medicare Advantage plans must cover Medicare-required services, but their provider networks, copayments, authorization procedures, and coverage rules can differ.

“Up to 100 days” does not guarantee 100 covered days. Coverage continues only while the individual meets the requirements for skilled care. Skilled care also does not always require improvement; qualifying care may sometimes be covered when needed to maintain a condition or prevent or slow deterioration.

If coverage is denied or ended, request the decision and appeal instructions in writing. Medicare beneficiaries have appeal rights, including faster review in certain time-sensitive situations.

5. Examine Home Health Care and Rehabilitation Benefits

Medicare may cover home health services when a person meets the eligibility requirements, is homebound, and needs medically necessary part-time or intermittent skilled care.

Covered care may include skilled nursing, physical therapy, speech-language pathology, continued occupational therapy, medical social services, and certain home health aide services provided as part of qualifying skilled care.

Medicare-covered home health care is different from non-medical in-home care. It generally does not provide continuous supervision, around-the-clock caregiving, housekeeping, meal preparation, or long-term personal care when those are the only services needed.

When comparing plans, ask:

• Which home health agencies are in-network?
• Is prior authorization required?
• Does the person need a referral?
• How many therapy visits may be approved at one time?
• How are additional visits requested?
• What will the member pay for home health or outpatient therapy?
• How does the plan coordinate care following a hospital discharge?

These questions can be particularly important after a fall, stroke, surgery, or serious illness. Knowing which agencies are covered before a crisis may reduce delays when your family is already under pressure.

6. Understand Prior Authorization and Appeal Rights

Prior authorization means the plan must approve a service, item, or medication before it will cover it. Depending on the plan, prior authorization may apply to skilled nursing care, home health care, rehabilitation, durable medical equipment, procedures, or prescription medications.

Before enrolling, ask:

• Which services your loved one may need require prior authorization?
• Who submits the request?
• What medical documentation is required?
• How quickly does the plan respond?
• Can an expedited decision be requested when waiting could harm the person’s health?
• How does the plan communicate a denial?
• What are the deadlines for appealing?

A member, authorized representative, or physician can ask the plan for an organization determination explaining whether a service or item will be covered and what the member may owe. If coverage is denied, the plan must provide written notice and information about the right to appeal.

Medicare provides additional information through its official appeals and complaints resources. Keep medical records, denial notices, plan correspondence, call notes, and confirmation numbers together

7. Check Prescription Drug Coverage

Medication coverage can change from year to year. A drug may move to a different tier, require prior authorization, become subject to step therapy, or cost more at a particular pharmacy.

The Medicare & You 2027 handbook states that the Part D deductible can be no more than $700 in 2027 for plans that have a deductible. It also states that out-of-pocket spending for covered Part D drugs is capped at $2,400 in 2027. After reaching that limit, the beneficiary pays $0 for covered Part D drugs for the rest of the calendar year.

If your loved one lives in a nursing home, verify that the facility’s long-term care pharmacy works with the plan. A facility may have an established pharmacy arrangement, and changing plans without checking compatibility could complicate medication access.

The Medicare Prescription Payment Plan also allows beneficiaries to spread covered prescription costs across the calendar year. This may make expenses easier to manage, but it does not lower the total cost of the medications.

8. Look Closely at Supplemental Benefits

Some Medicare Advantage plans offer benefits that Original Medicare does not provide. Depending on the plan, these may include:

• Transportation to medical appointments
• Meals following a hospitalization
• Over-the-counter allowances
• Personal emergency response systems
• Limited in-home support
• Certain home-safety modifications
• Dental, hearing, or vision services
• Benefits designed for people with specific chronic conditions

These benefits may be helpful, but they are often limited. Transportation may include only a set number of trips, meal delivery may last only briefly after discharge, and in-home help may provide few hours through an approved provider.

Ask:

• Is the benefit included in the exact plan available in the person’s ZIP code?
• Who qualifies?
• Is an assessment or doctor’s order required?
• How many hours, visits, trips, meals, or dollars are included?
• Which providers must be used?
• Are there copayments?
• Can the benefit be used while living in assisted living or memory care?

Do not assume that an advertised in-home benefit is comprehensive long-term care coverage. Supplemental benefits may support part of a care plan, but they are unlikely to replace ongoing paid caregiving, Medicaid, long-term care insurance, or family support.

If your family is comparing paid care at home with residential care, read 24/7 Home Care vs. Assisted Living vs. Memory Care: Which Costs Less?

9. Consider Whether a Special Needs Plan Could Be Appropriate

Medicare Advantage Special Needs Plans, commonly called SNPs, serve people with certain health or care circumstances. They may offer provider networks, prescription formularies, benefits, and care coordination designed for the population they cover.

There are three primary types:

Dual Eligible Special Needs Plans (D-SNPs) serve people who qualify for both Medicare and Medicaid. These plans may help coordinate benefits from the two programs.

Chronic Condition Special Needs Plans (C-SNPs) serve people with certain severe or disabling chronic illnesses. Depending on plan availability and eligibility rules, qualifying conditions may include dementia, diabetes, chronic heart failure, or other specified conditions.

Institutional Special Needs Plans (I-SNPs) serve certain people living in an institution, such as a nursing home, or people living in the community who require an institutional level of care.

A Special Needs Plan does not necessarily pay for room, board, or ongoing custodial care. However, its care coordination and network may fit some individuals better than a general Medicare Advantage plan.

Before enrolling, confirm eligibility and make sure the person’s doctors, facility, medications, pharmacy, and preferred hospital participate in the plan.

What If Your Loved One Lives in Assisted Living or Memory Care?

Medicare Advantage generally does not pay the regular monthly charge for assisted living or memory care. That charge commonly includes housing, meals, supervision, activities, and personal assistance.

The resident may still use Medicare Advantage for covered medical services, such as physician visits, hospital care, medications, therapy, medical equipment, and qualifying home health services. Before changing plans, ask which clinicians, home health agencies, therapy providers, laboratories, suppliers, and pharmacies regularly serve residents. Verify them with the proposed plan. Continuity can be especially important for someone living with dementia.

How Does Hospice Work with Medicare Advantage?

Hospice has different payment rules. When someone with Medicare Advantage elects the Medicare hospice benefit, Original Medicare generally pays the Medicare-certified hospice provider for care related to the terminal illness and related conditions. The person does not have to leave the Medicare Advantage plan simply because hospice begins.

Hospice may be provided at home or in a care community. Medicare generally does not pay a facility’s usual room-and-board charge simply because the resident receives hospice.

Learn more on our Hospice Care page and in our Hospice and End-of-Life Planning resources.

A Simple 2027 Medicare Advantage Checklist

Before choosing or renewing a plan, make sure your family has:

• Read the Annual Notice of Change
• Reviewed the Evidence of Coverage
• Compared total costs, not only premiums
• Confirmed important doctors, hospitals, and care providers
• Checked skilled nursing and rehabilitation coverage
• Reviewed home health agencies and rules
• Understood prior authorization requirements
• Entered every medication into Medicare Plan Compare
• Confirmed pharmacy access
• Reviewed the limits of supplemental benefits
• Considered whether a Special Needs Plan may apply
• Identified how non-medical long-term care will be paid for

Whenever possible, request important information in writing. Keep the name of each representative, the date of the conversation, and any confirmation number.

Where Can Families Get Unbiased Help?

You do not have to compare Medicare plans alone.

• Use the official Medicare Plan Compare tool.
• Call 1-800-MEDICARE (1-800-633-4227).
• Contact your local State Health Insurance Assistance Program for free, personalized Medicare counseling.
• Contact the plan directly for its coverage, cost, network, and authorization details.
• Ask providers to confirm participation in the exact 2027 plan.

An insurance agent or broker may also help explain available products. Ask which insurance companies the person represents and whether they can discuss every plan available in your area.

Making a Thoughtful Choice for 2027

Reviewing Medicare Advantage and long-term care needs is about more than comparing insurance premiums. It is about protecting access to familiar doctors, necessary medications, appropriate rehabilitation, and coordinated medical care during times of change.

No plan can remove every uncertainty. However, asking the right questions now may help your family identify gaps before they become urgent.

Focus on the services your loved one uses today, the needs that may reasonably develop, and the providers you would want involved after a hospitalization or health decline. If the choices feel overwhelming, pause and seek unbiased help. You are not expected to navigate every rule on your own.

Important: This article provides general educational information and is not individualized insurance, legal, medical, or financial advice. Medicare Advantage benefits, provider networks, costs, and coverage rules vary by plan and location and may change. Confirm plan-specific information with Medicare, the insurance plan, and the person’s healthcare providers. For free, unbiased Medicare counseling, contact your local State Health Insurance Assistance Program (SHIP).

Frequently Asked Questions About Medicare Advantage and Long-Term Care

Medicare Advantage and long-term care can be confusing, especially when families are comparing medical coverage with ongoing personal support. Here are answers to common questions about assisted living, memory care, nursing homes, home caregivers, prescription costs, and Medicare Open Enrollment for 2027.