Does Medicare Pay for Assisted Living

Summary: While Medicare doesn’t include coverage for expenses related to assisted living, there are certain plans available that might offer support for individuals requiring financial assistance for in-home services. We will outline the services covered by Medicare and suggest a few potential methods to assist in financing senior living. Estimated Read Time: 4 min

Table of Contents:

1. Understanding Medicare Assisted Living Costs and Coverage
2. Does Medicare Cover Assisted Living?
3. Does Medicare Cover Assisted Living for Dementia?
4. Do Medicare Advantage Plans Cover Assisted Living?
5. Would a Medicare Supplement Cover Assisted Living?
6. Does Medicare Offer Any Help with Assisted Living?

When you reach a certain age, it’s natural to need help with necessary parts of daily living. Things like bathing, getting dressed, or getting in and out of bed can become more difficult. It’s more than understandable that, for many seniors, the biggest fear is losing independence.

Assisted living facilities are a great way for older adults to maintain a level of independence and build community while still getting the help they need. However, these facilities are costly, especially for elderly Americans on a fixed income. Many seniors may wonder; Does Medicare cover assisted living costs?

Medicare won’t cover costs associated with independence, retirement, or assisted living. However, there are some plans that may provide relief for those in need of financial assistance. Below we’ll discuss the services that Medicare will cover and a few potential ways to help pay for senior living.

Understanding Medicare Assisted Living Costs and Coverage

Original Medicare (Medicare Part A and Part B) won’t pay for assisted living costs. The median annual cost of assisted living care in the United States is about $54,000 a year. When planning for retirement, it’s vital to consider saving for future daily living needs.

Medicare Part A, which covers inpatient hospital care, may provide limited coverage for a short-term stay in a skilled nursing facility following a hospitalization, but it does not cover the costs of residing in an assisted living facility.

Certain criteria must be met, such as having a qualifying hospital stay and requiring skilled nursing or rehab services, such as occupational and/or physical therapy, to be eligible for this limited coverage.

On the other hand, Medicare Part B, which covers outpatient services, may cover certain medical supplies and services that are medically necessary for individuals living in assisted living facilities.

These services may include doctor visits, preventive care, diagnostic tests, and durable medical equipment. However, Medicare Part B does not cover the cost of the assisted living facility itself or the non-medical assistance provided.

Does Medicare Cover Assisted Living?

While Medicare doesn’t cover assisted living, Medicaid might cover it in some states. If you need assistance with daily activities, you can look into local community programs, state programs, or other types of funding.

Other types of funding could include long-term care insurance, veterans’ aid, life insurance, a reverse mortgage, or an annuity that could help cover the costs.

It’s important to note that an assisted living community is not the same as a nursing home. Nursing homes, or skilled nursing facilities, are for those who need 24/7 care as opposed to some help with daily personal care.

Medicare can cover skilled nursing care for up to 100 days. But they won’t cover any additional days. So, while long-term care doesn’t have coverage, in some cases, short-term care does have coverage. Medicare covers intermittent nursing services that occur less than seven days a week, or less than eight hours a day, for 21 days or less. Although, if a doctor can give an accurate end-of-care estimate date, Medicare may cover for a longer time.

Does Medicare Cover Assisted Living for Dementia?

Even for those with Dementia, there is no coverage for assisted living communities. However, there is the Program for All-inclusive Care (PACE) for the elderly that are dually eligible for Medicare and Medicaid. Further, Medicare will fund hospice care when a doctor determines a life expectancy of 6 months or less.

Do Medicare Advantage Plans Cover Assisted Living?

Medicare Advantage plans, otherwise known as Medicare Part C,  can include benefits for some helpful home care services. These services could allow beneficiaries to continue living independently vs. transitioning into a full-time assisted living facility.

Some Medicare Advantage plans may include services such as home modifications, adult day care, activities of daily living, and transportation. But these services come with rules and restrictions.

Further, you need to understand that Medicare Advantage plans are not designed to cover assisted living costs. These extra benefits are purely for the promotion of aging at home.

It’s up to the Advantage carrier if they want to include these supplemental home care services as part of the plan’s benefits. Not all areas will have a plan that includes this type of coverage.

Would a Medicare Supplement Cover Assisted Living?

Since Original Medicare doesn’t cover these types of facilities, a Medicare Supplement (Medigap) plan won’t cover it either. But, Medigap can cover the costs Medicare doesn’t cover pertaining to doctor’s visits, hospital visits, surgeries, durable medical equipment, and more.

Does Medicare Offer Any Help with Assisted Living?

Funding assisted living can be a challenge since Original Medicare doesn’t cover this type of care. The specific insurance for coverage would be a long-term care policy. But those plans aren’t always the easiest to obtain and maintaining them can be even more challenging. Some experts suggest you could fund assisted living through a reverse mortgage, life insurance policy, or an annuity. Although even those methods of funding have pros and cons.

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