Does Medicare Pay for Assisted Living?

Assisted living facilities offer support with daily activities, like meals and housekeeping, while helping you maintain your independence.

But, does Medicare pay for assisted living? Typically, no. Medicare doesn’t pay for most assisted living expenses. However, there are some assisted living costs Medicare may cover in certain scenarios. Explore more about assisted living and Medicare coverage below.

What is assisted living?

An assisted living facility tends to offer a combination of independent living paired with care services offering help where you need it.

Assisted living isn’t the same as living in a nursing home. Nursing homes offer round-the-clock skilled nursing care. With an assisted living facility, residents typically live in their apartments or rooms and have access to common areas, dining rooms, and social activities. 

What services does assisted living offer?

Assisted living facilities provide a variety of services to help residents maintain their independence and well-being. These services may include: 

• Assistance with activities of daily living (ADLs): This includes help with personal care like bathing, dressing, grooming, eating, and toileting. 

• Medication management: When needed, staff can assist with administering medications as prescribed by a doctor. 

• Meals: Facilities usually provide three meals a day in a communal dining area. Even if a person has a kitchenette in their unit, having meals and friends to dine with is convenient.

• Housekeeping and laundry: Regular housekeeping and laundry services are available. 

• Transportation: Some facilities have a bus or van available for transportation to medical appointments or shopping trips. 

• Social activities: Many social and recreational activities, such as games, arts and crafts, exercise classes, and outings, are organized for those who wish to participate. 

• 24-hour supervision: Staff is available 24 hours a day to monitor residents' safety and well-being. 

Most assisted living facilities charge a base monthly fee, depending on the level of care you need.

Does Medicare pay for assisted living?

Original Medicare and Medigap Supplement health insurance plans don't typically cover the costs of assisted living. Some Medicare Advantage (Medicare Part C) plans might have more coverage for assisted living, but what's included varies by plan. Here's a breakdown of what's generally covered and what isn't:

What Medicare doesn't cover:

• Assisted living: Original Medicare (made up ofMedicare Part A and Part B) covers hospital stays, doctor visits, and some medical equipment. It doesn’t cover the costs of assisted living, which includes room and board, meals, and non-medical assistance with daily activities.

• Custodial care: Medicare generally doesn't cover custodial care (assistance with the activities of daily living like bathing, dressing, and eating), even if it's provided in an assisted living facility.

Medicare covers short-term medical services, not long-term care services. It will not pay for senior living expenses or assisted living coverage. Even if someone has Alzheimer's or needs memory care, Medicare generally won't pay for assisted living costs. That said, it will pay for inpatient hospital stays, doctor visits, diagnostic tests, and certain medications related to dementia.

What Medicare might cover under certain conditions:

• Skilled nursing care: If you need short-term skilled nursing care following a hospital stay, Medicare Part A may cover a portion of the inpatient hospital costs. However, this is typically covered in a skilled nursing facility, not an assisted living facility.

• Home health care: If you qualify for home health care, Medicare Part B may cover some services like physical therapy or occupational therapy, along with medical supplies and equipment.

• Hospice care: If a resident in an assisted living facility meets the eligibility criteria for hospice care, which includes a terminal illness with a life expectancy of six months or less, Medicare will cover the cost of hospice services. The hospice benefit covers skilled nursing care, physician services, medical equipment and supplies, counseling and therapy, and short-term stays in respite care to relieve caregivers. It does not include room and board costs, so the resident or their family will have to pick up those costs.

Anything Medicare doesn’t cover in these scenarios is paid out-of-pocket.

Get in touch with a Chapter Medicare Advisor to understand all of your Medicare benefits. Get in touch with an agent at 855-900-2427 or schedule a time to chat.

How much does assisted living cost?

Assisted living costs depend on the location and the level of care required. According to the Genworth Financial study, done every year, the average cost of assisted living is $5,350. However, the costs range from a low of $4,750 in Louisiana to a high of $7,025 in New Hampshire.

Other studies may report the cost differently, but it’s never cheap! For those living on Social Security without much in savings or other resources, assisted living may not be an affordable option.

How can I pay for assisted living if resources are limited?

People who were able to save for retirement may use savings, 401ks, annuities, stocks, investments, or life insurance cash-outs to supplement their Social Security. Older adults who were homeowners might sell their homes and use the profits for assisted living or take out a reverse mortgage.

Always speak to a financial advisor and a healthcare professional before making a decision on moving to an assisted living facility.

Assisted living communities typically review your financial situation before you move in. They can also help you create a long-term payment plan. You need to ensure you have the resources to continue to meet payments as facilities may discharge residents who can't meet the agreed payment terms. In a situation where payments aren’t met, facilities must follow strict rules and regulations for giving notice before eviction, and there are also some protections in place for residents.

Some options you could explore to help cover the costs of assisted living include:

• Medicaid: In some cases, Medicaid may cover some or all of the costs, but eligibility is based on income and asset limits. Eligibility also varies by state.

• Private long-term care insurance: A long-term care insurance policy may help cover the costs of assisted living but check with your insurer.

• Veterans' benefits: If you or your spouse are veterans, you may be eligible for VA benefits to help pay for assisted living.

• State programs: Some states have programs that provide financial assistance for assisted living, but eligibility varies.

Is assisted living covered in any state?

Many states offer programs that can help those with low-incomes pay for assisted living costs. Eligibility and the type of assistance vary widely. Here are some examples:

• California: Medi-Cal (California's Medicaid program) may cover assisted living costs through the Assisted Living Waiver (ALW) program. However, this program is not available in all counties, and there may be waiting lists.

• Florida: Florida offers the Statewide Managed Medical Care - Long Term Care program, which may cover some assisted living costs for eligible individuals.

• New York: New York has the Assisted Living Program (ALP), which provides subsidies for assisted living in select facilities. Eligibility is limited, and there may be waiting lists.

• Texas: The STAR+ Plus program may cover some assisted living costs for eligible individuals in Texas.

This is just a small sample of the states that offer financial support for assisted living. It's important to research the specific programs available in your state and contact your local Area Agency on Aging for more information.

To learn more about Medicare and what it will and won’t cover when it comes to assisted living and other levels of care, get in touch with a Chapter Medicare Advisor at 855-900-2427 or schedule a time to chat.