How to Find Assisted Living That Accepts Medicare
The search for affordable assisted living often reveals a startling reality for many families: Medicare plans provide little to no coverage for these communities. This coverage gap can create significant financial challenges for those who need support.
While Medicare won't cover the residential costs of assisted living, understanding what it does cover, can help make it more affordable. Families may use Medicare plans to cover healthcare costs in assisted living. They can then use alternative payment options, like Medicaid waivers, long-term care insurance, and personal retirement funds, to pay for the remaining costs.
Key Takeaways
Medicare doesn’t cover room and board or personal care services in assisted living facilities.
Medicare may cover medical services like doctor visits, physical therapy, and prescription medications.
Alternative payment options include Medicaid waiver programs, long-term care insurance, veterans’ benefits, and various private payment options.
When searching for affordable assisted living, talk to different communities to determine if they work with Medicare or Medicare Advantage and which services might be covered.
Medicare coverage for assisted living
Original Medicare (made up of Parts A and B) does not cover the standard cost of assisted living facilities. That said, Medicare may cover some of the costs of approved services like hospital stays, healthcare appointments, and medical procedures while you live at an assisted living facility.
For example, if you receive medically necessary physical therapy at the assisted living facility, Medicare may help cover those expenses.
Medicare Part A (inpatient insurance) does cover eligible short-term stays within a skilled nursing facility after an inpatient hospital stay.
After 20 days of care, you’re responsible for a $204 daily coinsurance. After 100 days, you’re responsible for paying 100% of the cost of your stay out of pocket. Skilled nursing facilities typically focus on a much higher level of medical care compared to assisted living facilities.
Medicare Advantage plans also don’t cover standard assisted living. They may cover additional services worth noting, like meal delivery or transportation. Coinsurance amounts and covered services vary significantly depending on your plan.
Medicare Advantage assisted living coverage
Like Original Medicare, Medicare Advantage (Part C) doesn’t cover assisted living facility costs.
Some Part C plans, however, might cover specific services that are similar to services offered by assisted living facilities. This may include help with:
Activities of daily living (ADLs)
Transportation to healthcare appointments
Meal coordination and delivery from third-party services
As a result, Medicare Advantage plans may cover some costs that are incurred within an assisted living facility (such as covering additional transportation fees), but not general residence and non-medical costs.
How to find assisted living facilities that accept Medicare
Though Medicare and Medicare Advantage plans don’t cover most residential and non-medical fees from assisted living, some facilities will accept Medicare or Medicare Advantage to pay for covered services.
This means that you’d pay any costs associated with room, board, and non-medical services yourself, but select services like transportation to healthcare appointments could be covered by your Medicare or a Medicare Advantage plan.
Resources to consult
Since Medicare plans may only cover skilled nursing facilities and not assisted living residence costs, it can be difficult to determine which communities accept Medicare for covered services.
You can start by searching through a directory from organizations like SeniorLiving or Assisted Living Locators, which will give a list of assisted living facilities near you. You can then review their websites and get in touch with different facilities to ask about Medicare coverage.
Questions to ask facilities about Medicare coverage
When talking to an assisted living facility, asking the right questions can help you understand whether your Medicare benefits will cover any costs.
You can ask the following:
Do you work with specific Medicare Advantage plans, and if so, which ones?
Does my Medicare plan cover any in-house services?
Can you help me coordinate with healthcare providers or third-party services that do accept Medicare, including transportation or meal delivery services?
If you have Medicare Advantage, you can also reach out to your plan provider. They may have information about facilities that have or facilitate in-network services.
Alternative payment options for assisted living
Since Medicare doesn't cover most assisted living costs, families can explore alternative options for paying facility fees. Below, we dive into different options for seniors on Medicare to cover the cost of assisted living expenses.
Medicaid waiver programs for assisted living
Most states offer some assistance for assisted living through Medicaid waivers.
Medicaid may not cover room and board costs, but it could help cover services provided by the facility. Some states also offer additional programs to help with room and board expenses.
To qualify for Medicaid assistance for assisted living, you must:
Meet both low-income and asset financial eligibility requirements
Demonstrate a need for the care that would be provided
Be a resident of the state where you're applying
You can contact your state's Medicaid office for guidance on available programs and to learn more about your Medicaid assisted living options.
Long-term care insurance options
Long-term care insurance can be an excellent option if it’s purchased before care is needed. These policies cover expenses that traditional health insurance and Medicare don't, often including assisted living costs.
Key considerations for long-term care insurance include:
Policies typically cover a daily or monthly benefit amount for a set period (often three to five years).
Coverage usually begins when you need help with at least two activities of daily living.
Pre-existing conditions may limit coverage options.
Some policies have waiting periods (typically 30-90 days) before benefits begin.
If you already have a life insurance policy, check whether it offers accelerated death benefits or if it can be converted to a long-term care benefit plan. These options allow you to access death benefits while you’re still alive to pay for long-term care.
Veterans' benefits for assisted living
Veterans and their surviving spouses may qualify for significant financial assistance through the Department of Veterans Affairs (VA).
The most relevant VA benefit for assisted living is the Aid and Attendance (A&A) benefit, which is a monthly payment added to a veteran's pension. To qualify, you must meet the following criteria:
Have served at least 90 days of active duty with at least one day during a period of war
Must require assistance with activities of daily living
You meet the income and asset limits
The application process can take several months, so it's best to apply as early as possible. Veterans can receive assistance with the application through their local VA office or accredited veterans service organizations.
Private pay options and financial planning strategies
Many families primarily use private payment to cover assisted living costs. There are several options you can use to help cover assisted living expenses, including:
Leveraging home equity by selling an existing home, using a reverse mortgage, or taking out a home equity line of credit to access cash.
Using annuities or systematic withdrawals from your retirement account to create steady income.
Receiving assistance from family members who can help cover the costs of assisted living. This support may qualify for gift tax exclusions if structured properly.
When evaluating private pay options, consider not just the current monthly costs but also how expenses may increase over time. Many facilities raise rates annually, and the level of care needed often increases as residents age.
Working with a financial advisor who specializes in elder care can help families develop comprehensive strategies that protect assets while ensuring quality care for their loved ones.
Navigating the application process
Applying for financial assistance for assisted living requires careful planning and attention to detail. Understanding what to expect can help families navigate this often complex journey.
Required documentation
Gathering documentation is the first step in any financial assistance application. Most programs will require the following:
Personal identification, including a government-issued ID, Social Security card, and birth certificate
Financial records, including bank statements and investment account information
Medical documentation, including medication lists, physician statements, and health records
Application processes can be complicated and approval can take a long time. Preparing the necessary documentation will help you complete applications faster and speed up approval timelines.
Timeline considerations
Timing is crucial when planning for assisted living financial assistance.
Medicaid applications typically take 45-90 days for processing, while Veterans Aid and Attendance benefits can take 6-12 months.
That said, be aware of waiting and look-back periods. Medicaid, for example, has a five-year look-back period for asset transfers. Long-term care insurance policies often have 30-100 day waiting periods before benefits begin.
Working with financial advisors or elder law attorneys
Professional guidance can be invaluable when navigating complex financial assistance programs and determining how you’ll pay for assisted living.
Elder law attorneys can help you determine which programs you may be eligible for. They can also help you establish trusts and take advantage of asset protection strategies.
Financial advisors with Certified in Long-Term Care (CLTC) or Certified Senior Advisor (CSA) credentials can evaluate your finances and create long-term care funding strategies.
If you aren’t sure where to get started, many Area Agencies on Aging also offer free benefits counseling to help identify programs and financial planning strategies that may help your family.
Mistakes to avoid
Common mistakes can delay or disqualify financial assistance applications. These are the most significant mistakes to avoid:
Gifting assets without understanding the look-back period consequences
Submitting incomplete applications with missing documentation
Waiting until crisis mode to begin the application process
Relying solely on facility staff for complex financial advice
Failing to disclose all assets and income sources
Missing opportunities for tax deductions or credits
Not exploring all available payment options.
Choosing facilities without verifying that they accept your planned payment method
Bottom line
While Medicare plans do not cover room and board fees for assisted living communities, some Medicare and Medicare Advantage plans cover eligible costs for services received while you live in a facility.
Since Medicare doesn’t cover most assisted living costs, it’s important to find a facility that you can afford on an ongoing basis.
Alternative payment options can help cover some costs. Strategically using retirement funds, home equity, long-term care insurance benefits, or family member assistance can help you pay for the care you need.
Don’t forget to shop around when considering different communities. Some facilities cost significantly more than others, and some may work with Medicare Advantage plans to cover eligible services. If you can find assisted living facilities that accept Medicare for eligible services, it can save you a lot of money and make assisted living more affordable.
If you’re unsure what your Medicare plan covers, we can help. Chat with us today at 855-900-2427 or book an appointment ahead of time.
FAQs
Does Medicare pay for assisted living facilities?
No, Medicare doesn’t cover room and board or personal care services in assisted living facilities. Medicare may cover specific healthcare services like doctor visits, therapy, and skilled nursing care while you're in assisted living.
What's the difference between Medicare and Medicaid for assisted living?
Medicare is federal health insurance that doesn't cover assisted living costs.
Medicaid is a state-federal program for those with limited income. Medicaid may help pay for services in assisted living facilities through waiver programs, though it typically doesn't cover room and board.
Can I use Medicare to pay for memory care in assisted living?
Medicare doesn't cover memory care residence costs in assisted living facilities. It may cover medically necessary care for dementia patients, such as doctor visits and some therapy services. Some Medicare Advantage plans may offer additional coverage for services related to memory care, but not for housing costs.
Sources
National Council on Aging. (2023, June 22). Will Medicaid pay for assisted living? https://www.ncoa.org/article/does-medicaid-pay-for-assisted-living/
U.S. Department of Veterans Affairs. (2025, March 17). VA health benefits: Long term care. https://www.va.gov/health-care/about-va-health-benefits/long-term-care/