Does Medicare Cover a Long-Term Care Hospital (LTCH)? 2026 Costs

Yes, Medicare covers a long-term care hospital (LTCH) under Part A, and in 2026 you pay $0 a day for days 1 through 60 after the $1,736 deductible.1 If a doctor has just told you your parent is moving to a "long-term care hospital," it's natural to hear "nursing home" and brace for a bill Medicare won't touch. But a long-term care hospital is a hospital, not a nursing home, and Medicare Part A covers care in a long-term care hospital.2,1

In This Guide

• What a Long-Term Care Hospital Is
• What You Pay for a Long-Term Care Hospital With Medicare in 2026
• Why You Often Owe No Second Deductible
• If the Long-Term Care Hospital Stay Runs Long
• Long-Term Care Hospital vs Skilled Nursing Facility vs Custodial Care Under Medicare
• What Medicare Covers After a Long-Term Care Hospital Stay
• If You Have Medicare Advantage or Other Coverage
• Frequently Asked Questions
• Your Next Steps
• Learn More

What a Long-Term Care Hospital Is

The words "long-term care" carry a lot of weight when you're the one sitting in a hospital hallway. So start with the plain fact: a long-term care hospital is a hospital, not a nursing home. Section 1886(d)(1)(B)(iv)(I) of the Social Security Act defines a long-term care hospital as "a hospital which has an average inpatient length of stay (as determined by the Secretary of Health and Human Services (the Secretary)) of greater than 25 days."2

According to Medicare.gov, LTCHs typically care for patients with more than one serious medical condition, and those patients may improve with time and care and eventually return home.1 Medicare.gov lists services an LTCH may offer, including:

• Respiratory therapy
• Head trauma treatment
• Pain management1

What the 25-day average really means

You may hear that an LTCH has a "25-day" rule, and it's easy to read that as a countdown on your parent's bed. It isn't one. The federal regulation at 42 CFR 412.23(e) says a long-term care hospital "must have an average Medicare inpatient length of stay of greater than 25 days (which includes all covered and noncovered days of stay of Medicare patients)."2 The 25-day figure in Medicare's long-term care hospital rules is a requirement the hospital must meet, measured as an average across its Medicare patients' stays, and neither the statute nor the regulation states it as a minimum or maximum length of stay for any individual patient.2

What You Pay for a Long-Term Care Hospital With Medicare in 2026

Once you know Part A is paying, the next worry is usually the bill. Medicare measures what you owe for an LTCH stay per benefit period, and the 2026 amounts come from the Federal Register notice that sets the calendar-year 2026 Part A inpatient hospital deductible and coinsurance.1

Medicare.gov's long-term care hospital coverage page lists these same 2026 Original Medicare Part A amounts.1 For most families, the first row is the one that matters, and the next section explains why the deductible in that row may already be behind you.

Why You Often Owe No Second Deductible

This is the part of the LTCH bill that surprises people in a good way. It turns on how Medicare defines a benefit period.

Under Medicare Part A, a benefit period begins the day a person is admitted as an inpatient in a hospital or skilled nursing facility (SNF), and it ends when the person hasn't gotten any inpatient hospital care (or skilled care in a SNF) for 60 days in a row.1 The Part A inpatient hospital deductible is owed for each benefit period, a new benefit period begins if the person goes into a hospital or SNF after the previous one ended, and there's no limit to the number of benefit periods.1

That's why Medicare says you don't pay the Part A deductible for long-term care hospital care if you were already charged a deductible for a prior hospital stay within the same benefit period: the benefit period starts on day one of that prior hospital stay, and that stay counts towards the deductible.1 Medicare.gov gives two examples where no deductible is owed for long-term care hospital care:

• The patient is transferred to a long-term care hospital directly from an acute care hospital.1
• The patient is admitted to an LTCH within 60 days of being discharged from a hospital.1

Because Medicare lists the 2026 day ranges per benefit period, and a benefit period can start with an earlier hospital stay, ask the LTCH's billing office where your parent stands in the day count for the current benefit period.1

If the Long-Term Care Hospital Stay Runs Long

Nobody wants to plan for a long stay, but knowing where the thresholds fall can take some of the fear out of the numbers. Under Original Medicare Part A in 2026, the $0 days in a long-term care hospital end after day 60 of a benefit period: from day 61 the patient owes a daily coinsurance, and the daily amount rises on day 91, when Medicare starts drawing on lifetime reserve days (the 2026 cost table above has the amounts).1

Reserve days are the part to watch. Medicare.gov describes lifetime reserve days as additional days Medicare will pay for when you're in a hospital for more than 90 days, with a total of 60 reserve days that can be used once during your lifetime, so a reserve day used on this stay isn't there for a later one.1 If your parent's stay looks likely to pass day 90, talk it through with the hospital's billing office early. After day 150 of a benefit period, an Original Medicare patient pays all costs for a long-term care hospital stay.1

There is one reset. A Medicare Part A benefit period ends after 60 days in a row with no inpatient hospital care and no skilled care in a SNF, and the next admission starts a new benefit period with a new deductible, as worked example #2 shows.1

Long-Term Care Hospital vs Skilled Nursing Facility vs Custodial Care Under Medicare

Families often hear three kinds of care named in the same week, and they are paid for very differently. Here is how an LTCH, a skilled nursing facility and custodial long-term care compare under Original Medicare in 2026.1,2,3

Two details are worth knowing. Medicare.gov states the 3-day qualifying inpatient hospital stay rule for skilled nursing facility care, and time spent under observation or in the emergency room before admission doesn't count toward those 3 days, even overnight.3 The 3-day rule isn't always a dead end: Medicare.gov says you may not need a 3-day minimum inpatient hospital stay if your doctor participates in an Accountable Care Organization (ACO) that's approved for a Skilled Nursing Facility 3-Day Rule Waiver, a Medicare Advantage plan may also waive the 3-day minimum, and a patient without a qualifying stay can ask whether other programs, like Medicaid or veterans' benefits, can cover SNF care.3 Brevy's guide to hospital observation status walks through what to do if a hospital changes your parent's status from inpatient to observation. And for a SNF, Medicare.gov says you don't have to pay the Part A deductible if you already paid it for hospital care during the same benefit period, the same benefit-period logic that often spares a second deductible at an LTCH.3

What Medicare Covers After a Long-Term Care Hospital Stay

Leaving the LTCH is its own decision point, and it's fine to feel unready for it. According to Medicare.gov, after discharge from a long-term care hospital, many people get care in a skilled nursing facility or custodial care in a long-term care facility.1

If the next step is a skilled nursing facility, Medicare Part A covers up to 100 days of SNF care per benefit period, with 2026 costs of $0 a day for days 1 through 20 after the $1,736 deductible and $217 a day for days 21 through 100.3 Brevy's skilled nursing facility cost guide covers that stay in detail.

If the next step is custodial care, the money picture changes. Medicare doesn't pay for long-term custodial care, which Medicare.gov describes as care that mostly helps with basic personal tasks of everyday life, sometimes called activities of daily living.3 Medicare.gov says a person who isn't eligible for long-term care under Medicare may be eligible for it through Medicaid (if they meet eligibility requirements in their state), or can choose to buy private long-term care insurance.3 Our guide to why Medicare doesn't pay for long-term care explains where that line falls.

If You Have Medicare Advantage or Other Coverage

The 2026 amounts in this guide are Original Medicare Part A amounts, and what a person with a Medicare Advantage plan or other coverage pays for a long-term care hospital stay can differ.1 For a question about a Medicare Advantage plan, CMS directs people to contact the plan first, using the phone number on the plan member ID card, and to call 1-800-MEDICARE if the plan can't resolve it.4

Your Next Steps

You don't have to sort all of this out in one afternoon. A few calls will get you most of the way:

1. Ask the LTCH's billing office whether the stay continues the benefit period that began with the earlier hospital stay, and whether a deductible has already been charged.
2. Call 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048) with Original Medicare questions. 1-800-MEDICARE takes calls and live chats 24 hours a day, 7 days a week, except some federal holidays.4
3. Start discharge planning early. Our hospital discharge planning guide covers what to ask before your parent leaves.
4. If you believe your parent is being discharged too soon, or Medicare denies part of the stay, read Brevy's guides to Medicare fast appeals and how to appeal a Medicare denial.

Learn More

Find personalized help planning your parent's discharge from a long-term care hospital at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.