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Does Medicare Pay for Assisted Living


Medicare won’t cover costs associated with independent, retirement, or assisted living. Now, there are some plans that may provide some relief for those in need of help. Below we’ll discuss the services Medicare will cover and how you can pay for senior living.

Understanding Medicare Assisted Living Costs and Coverage

First, Medicare won’t pay for assisted living costs. The median annual cost of assisted living care is about $48,000 a year. When saving for retirement, it’s vital to consider saving for needing assistance with daily activities.

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, reverse mortgage, or an annuity that could help cover the costs.

Now, Medicare can cover up to 100 days in a skilled nursing facility. 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 facilities. Now, there is the Program for All-inclusive Care (PACE) for the elderly that qualify for Medicare and Medicaid. Further, Medicare will cover hospice when a doctor determines a life expectancy of 6 months or less.

Do Advantage Plans Cover Assisted Living?

Medicare Advantage plans now include benefits for some supplemental home care services. These supplemental services could allow beneficiaries to continue living independently vs. transitioning into a full-time assisted living facility. 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.

Does Medigap Cover Assisted Living?

Since Medicare doesn’t cover these types of facilities, Medigap 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.

Which Medicare Plan is Best for Assisted Living?

Some Medicare Advantage plans may include services such as home modifications, adult daycare, activities of daily living, and transportation. But, these services come with rules and restrictions. Further, you need to understand that Advantage plans are not designed to cover assisted living. These extra benefits are purely for the promotion of aging at home.

How to Pay for Assisted Living with Medicare

Funding Assisted living can be a challenge since 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 ways of funding have pros and cons.

FAQs

Is there financial assistance for assisted living?
Medicaid is the most common way to pay for an assisted living facility when you have low funds. Or, if you don’t have low enough funds for Medicaid, ask if the facility has options for a roommate that would lower costs.
How to complain to Medicare about an assisted living facility?
You wouldn’t complain to Medicare about one of these facilities, especially since Medicare doesn’t even cover that type of care. Instead, you’d contact the local Long Term Care Ombudsman Program to help you file a complaint to the agency.
How do you find assisted living that accepts Medicare?
Medicare does not pay for assisted living, so there are no assisted living facilities that accept Medicare. Most people pay for assisted living with their personal funds, which include retirement accounts and Social Security payments.

How to Get Help with the Cost of Assisted Living

While Medicare can't help cover Assisted living, life insurance, or long-term care insurance can help! If you would like more information on your Medicare options, give us a call. We're more than happy to answer any questions you have about your benefits and eligibility. We can provide you with plan comparisons in your area that include benefits for supplemental home healthcare. Give us a call at the number above or use our rate comparison form to see rates now.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “Does Medicare Pay for Assisted Living

  1. Hi , My Name is Randall J. Stephenson , I have Medicare Advantage plan and Medicaid. I have been on S.S.D.I. since 2012. Is there anyway for me to get finacial help with the cost of ALF in the future, because I know I will need ALF. I already can’t walk or stand for more that 15 mins. without SERIOUS PAIN. Any help would be really helpful.

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