A leading Senate Democrat is exploring a major expansion of Medicare that could help older Americans and people with disabilities pay for long-term care at home.
Ron Wyden, the ranking Democrat on the Senate Finance Committee, released a request for information on Friday for feedback on options to overhaul America's long-term care system.
He floated the idea of establishing a new Medicare home care benefit as well as expanding access to home care through Medicaid. Improving nursing-home care and strengthening the overall long-term care workforce were also priorities in his request.
“Long-term care and the decisions that surround it are among the most personal and sensitive any American family must face. Today, those decisions are too often driven by financial considerations rather than what is best for a loved one and their family,” Wyden said.
The request is part of Wyden's larger effort to develop Democrats' future health care agenda.
Why It Matters
If ultimately enacted, a broader Medicare home care benefit would mark a significant change from current coverage. Medicare pays for certain medically necessary home health services for eligible beneficiaries, but it generally does not cover round-the-clock home care.
Medicare covers certain skilled nursing, therapy and home health aide services for eligible beneficiaries, but home health aide coverage is available only when a beneficiary is also receiving qualifying skilled services. Medicare specifically does not pay for 24-hour home care or home meal delivery.
Medicaid, on the other hand, is the country's primary payer for long-term services and supports and accounts for more than half of U.S. long-term care spending, according to KFF.
That means many middle-income families are facing substantial costs if they need ongoing help but don't qualify for Medicaid.
The national median cost of a non-medical caregiver reached $35 per hour in 2025, or $80,080 annually based on 44 hours of care a week, according to CareScout's latest Cost of Care Survey.
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What To Know
Wyden's Finance Committee staff is asking for feedback across three broad areas:
- Making home care more affordable and accessible, particularly for seniors and people with disabilities.
- Improving the quality of nursing-home care.
- Strengthening the long-term care workforce.
For home care, the document considers multiple routes rather than presenting a single finished legislative proposal.
One avenue would involve establishing a new Medicare home care benefit. Another involves using Medicaid to create a universal home care benefit.
“Senate Democrats are determined to deliver an equitable and affordable home care guarantee for all Americans in need, improve the quality of long-term care across the board, and make sure there are workers in good jobs to meet that need,” Wyden said. “That starts by hearing from all corners of the country on the ideas put forward in this document. I look forward to creative, robust and thorough responses that put Americans who need long-term care at the center."
How Would Medicare Change?
The major difference for beneficiaries would be whether Medicare takes on a larger role in paying for ongoing home-based support.
Medicare already has a home health benefit, but it isn't a comprehensive long-term care benefit. Eligible people can receive medically necessary intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology and some home health aide services.
But crucially, Medicare does not cover personal or custodial care when that is the only care required.
“Long-term care has always been one of the major financial challenges facing retirees,” Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek.
“Many either purchase overly expensive insurance policies or eventually deplete much of their assets to cover the cost of care. By introducing a universal long-term care initiative, the goal is to provide these services based on need rather than financial assets.”
The earlier Democratic initiative announced in May explicitly called for developing a policy that would "establish a home care guarantee for people with Medicare." It also sought policies that would allow middle-income families to access care without exhausting their savings.
“Medicare can pay for your surgery, but generally won't pay someone to help you get dressed six months later. That's the enormous hole Wyden is trying to address,” Michael Ryan, a finance expert and the founder of MichaelRyanMoney.com, told Newsweek.
“For seniors, affordable home care could mean staying in their own homes instead of draining retirement savings or relying on family members who may have to leave their jobs to provide care.”
How Much Could Home Care Save Families?
The financial stakes for families are substantial.
CareScout's 2025 national cost data show median annual expenses of a non-medical caregiver at $80,080, assuming 44 hours a week.
Meanwhile, adult day health care was priced at $24,700 and assisted living at $74,400.
“Democrats are prioritizing this because long-term care is both a healthcare problem and a financial crisis for families. Medicaid cuts, an aging population and caregiver shortages make that problem harder to ignore,” Ryan said.
“But I wouldn't expect relief anytime soon. This is a request for input, not legislation.”
Democrats' Broader Long-Term Care Push
Friday's request builds on an initiative Wyden launched with 16 other Senate Democrats in May.
At the time, the senators identified three priorities: making home care affordable and accessible, improving care in nursing homes and strengthening the long-term care workforce.
"America is failing people who are aging and those with disabilities, who should have every opportunity to live at home and thrive in their communities," the senators said in May.
"Democrats want to ensure American families have affordable, high-quality care in the setting they choose and quality jobs and living wages for direct care workers."
Democrats understand which voting blocs can move the needle in elections, Thompson said.
“Seniors are among the most politically engaged voters, particularly when it comes to legislation and policies that directly affect their demographic. However, I do not foresee this coming to fruition anytime soon,” he said.
“The biggest obstacle is cost. Long-term care is already extraordinarily expensive, and many private insurers have either exited the market or significantly reduced coverage because the financial risks have become too great.”
What Happens Next
For Medicare recipients, nothing is changing immediately.
Wyden's newly released request is now seeking information designed to solicit feedback on potential policies, not legislation itself establishing a new Medicare benefit.
“Congress still has to answer two expensive questions: Who pays for universal care, and where will the caregivers come from? You can promise home care on paper. Finding someone qualified to provide it is another matter,” Ryan said.
Newsweek’s reporters and editors used Martyn, our AI assistant, to produce this story. Learn more about Martyn here. Contact Newsweek editors on this story: Jason Lemon and Gray R. Thomas