Does Medicare Pay for Assisted Living?

December 16, 2022

Medicare doesn’t cover assisted care in an independent living facility or nursing home. But there are other ways to pay for independent or assisted living. (Read more about the difference between assisted and independent living here.)

Find out what’s covered by Medicare.

If you’re looking for assistance with paying for assisted or independent living, you might consider using Medicaid as a source of funding. Medicaid covers some services at skilled nursing facilities, such as rehabilitation therapy, speech therapy, occupational therapy, and medical equipment. It also pays for some services at intermediate care facilities, such as personal care and respite care.

Assisted living costs covered by Medicare

Medicare usually won’t cover custodial care, but under certain conditions, it may cover skilled nursing care. This is care usually provided or supervised by a certified nursing professional or doctor. It includes services like physical therapy or changing sterile dressings. In assisted living environments, this care may be covered by Medicare Part A.

However, you won’t usually get skilled nursing care at an assisted living facility. Assisted living normally provides custodial care and supervision, but not the type of medical treatment typically found in a nursing home. But there are a few things in an assisted living facility that Medicare may help cover, such as transportation to doctors’ appointments or some preventive health services. (See: What’s the difference between assisted and independent living?)

Do Medicare Advantage plans include assisted living coverage?

Medicare Advantage, sometimes called Medicare Part C, may help cover some long-term care costs. Medicare Advantage plans are offered through private insurers and include everything covered by Part A and Part B. These plans also sometimes help pay for services not offered by Part A and Part B, like personal or custodial care. Not all Medicare plans are the same. Costs and coverage options may vary from plan to plan or between insurance providers.

Eligible Medicare long-term care coverage

Medicare Part A may cover skilled nursing care in some long-term settings. However, Part A only pays for these services for up to 100 days. Medicare Part A can help cover skilled nursing care in certain conditions for a limited time if all of these conditions are met:

You have Part A and have days left to use in your Medicare benefit period
You have a qualifying hospital stay
Your doctor decided that you need daily skilled care
The skilled nursing facility (SNF) where you get skilled services is certified by Medicare
You need these skilled services for a medical condition that’s either:
- A hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay, even if it wasn’t the reason you were admitted to the hospital
- A condition that started while receiving care in the SNF for a hospital-related medical condition (for example, you develop an infection that requires IV antibiotics while getting SNF care)

Look into private insurance plans

If you’re looking at assisted living facilities, you might consider using an insurance plan that covers assisted living costs. Private insurance companies often offer these plans as part of their retirement packages.

Medicaid includes coverage for assisted living costs

Medicaid is a joint federal and state program that may provide some coverage for assisted living. Not everyone qualifies for Medicaid. The types of care covered by Medicaid and income qualifications for the program vary from state to state. Visit Medicaid’s state overviews list for more information on what Medicaid covers in your area.

Check with your state Medicaid agency.

You should check with your state Medicaid agency to find out whether they will cover assisted living costs. They may not cover everything, so make sure to ask what’s covered before making any decisions.

How much does assisted living cost?

The price of assisted living can vary based on several factors. According to the 2021 Genworth Cost of Care Survey, the average cost of assisted living in the U.S. is $4,500 a month. It’s important to remember that what you pay for assisted living may differ based on where you live, the type of facility you choose, or the level of care and service provided.

Alternate ways to pay for assisted living costs

Medicare Part A only covers skilled nursing care and only for up to 100 days. If you need help with other costs of assisted living, you may have other options:

Medicaid: Along with Medicare, Medicaid may help you cover some of the costs of long-term care. Your eligibility for Medicaid depends on your income. This eligibility requirement may vary from state to state, along with the services covered by Medicaid. Visit the Medicaid State Overview page to see details of Medicaid coverage where you live.
Social Security Administration Programs: Depending on your medical condition or income, you might qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Social Security also offers “compassionate allowances” for people with certain serious conditions to help them get disability benefits more quickly.
Long-term care insurance: These are plans offered through private insurance providers. They may cover several types of long-term care. Details of coverage and costs may vary from plan to plan.

When assisted living facilities make sense

Making a move to an assisted living facility is a big decision. Even if you can live on your own, the National Institute on Aging recommends talking to friends and family to make a plan for long-term care in the future. Planning ahead could help you navigate assisted living costs and make informed decisions based on your needs. People with Alzheimer’s disease or other cognitive impairments should make plans for long-term care as soon as they can. Generations is proud to offer Independent Living, Assisted Living, Memory Care and Post-Acute Care. Contact us today. We’re here to answer your questions.