Medicare

Does Medicare Cover Assisted Living?

While Medicare does not pay for assisted living, long-term care insurance and some types of life insurance will. Learn common strategies to pay for or reduce the cost of assisted living.

does medicare cover assisted living

Assisted living communities provide living arrangements for older adults who need help with daily activities such as meal preparation, medication management, bathing, and dressing. As part of inhabiting an assisted community, residents receive meals served in dining rooms, housekeeping/laundry services, fitness centers, and social activities. Many older adults appreciate living in this arrangement because it allows them to stay active and socialize with others their age while providing safety and assistance when needed.

Unfortunately, assisted living can be expensive. If you’re a Medicare recipient and considering assisted living, you might wonder if Medicare covers the cost.

Does Medicare Cover Assisted Living? 

Medicare, the federal health insurance for adults 65 and older, people with disabilities, or diagnosed with end-stage renal disease, does not cover assisted living. However, if someone in assisted living needs medication or health care, Medicare covers that cost.

Generally, when a doctor visits someone in assisted living, Medicare pays the provider. If the doctor prescribes a resident’s physical therapy or medical equipment, Medicare covers it. Although Medicare pays for health care when you’re in assisted living, it won’t pay for room and board. 

Skilled Nursing Facilities and Medicare 

Medicare Part A covers skilled nursing care after a hospital stay of 3 or more days for a limited time. Medicare fully covers the cost of SNF for up to 20 days. If the patient requires care for longer than 20 days, Medicare subsidizes a portion of it, with the patient responsible for a copay of $194.50 daily.

In a skilled nursing facility (SNF), registered nurses care for patients supervised by a doctor with a level of care comparable to a hospital. Patients go to an SNF to recover after an illness, injury, or surgery. The services provided include physical, occupational, or speech therapy.

The Value of Assisted Living

Because Medicare does not cover assisted living services, the patient must pay for those services independently. Unfortunately, assisted living services may be quite expensive, often costing tens of thousands of dollars per year. If you are interested in assisted living but concerned about the price and value, you should keep in mind that this care often covers all your needs, including:

  • Meals
  • Laundry
  • Housekeeping
  • Entertainment
  • Physical Fitness Services

Therefore with all of your needs met, assisted living may be a good option for many seniors looking to maintain their independence while getting the care they need.

How to Pay for Assisted Living Services

Because Medicare does not cover assisted living, many who desire it may think they cannot afford it. Luckily, there are solutions to the high price of this care. Here are several of the most popular:

Long-Term Care Insurance 

Long-term care insurance pays all or part of the cost of assisted living up to the monthly benefit limit. It also covers adult day care, home care, and nursing home care. To qualify for long-term care insurance, you must be unable to complete two or more of the following six activities classified as essential to independent living:

  • Bathing
  • Using the Restroom
  • Continence
  • Eating
  • Transferring (getting out of a seated position)

The downside of long-term care insurance is that, as with many other insurance schemes, you must buy it before you need it. Additionally, you won’t qualify if you are over 75 or have certain health conditions. If you’re curious about which specific health conditions will reduce your ability to gain coverage, make sure to inquire with your potential future insurer.

Life Insurance 

Depending on your policy, you might be able to use life insurance to pay for long-term care, including assisted living. A policy with an accelerated death benefit pays while you are alive under certain circumstances. Combination life/long-term care policies can also pay for long-term care if needed. To see if you qualify, read your policy or check with your agent.

Medicaid 

Medicaid, the public health insurance program for low-income adults, covers some of the cost of assisted living. Eligibility requirements vary by state, but you must have minimal assets and a low income. Most states cover homemaker and nursing services received in assisted living but not the cost of room and board. 

Pensions and Retirement Savings 

Many people pay for assisted living from their income and assets. If you cannot pay for assisted living out of pocket, you may be able to utilize savings from financial assets you’ve already paid into.

In some scenarios, you can use a pension, social security payments, 401K, or IRA to cover your rent. Additionally, homeowners can consider selling their homes and using the equity to pay for their care.

VA Benefits 

Veterans may access assisted living benefits through the VA. To be eligible, a veteran must sign up for VA healthcare, qualify as “needing care,” and have a nearby care facility. If you qualify, the VA benefit offsets a part of the cost of assisted living. 

Programs for All-inclusive Care for the Elderly (PACE) 

In some states, Programs for All-Inclusive Care for the Elderly (PACE) cover all care provided by Medicare or Medicaid. It also pays for services to help a person with a disability or memory loss remain at home with the support of part-time care providers or relatives. PACE might cover assisted living if recommended by its health team. Visit Medicare.gov to see if PACE is available in your area.