Does Medicare Pay for Assisted Living?

Medicare only pays for long-term care if you require skilled nursing services for support in daily living and need occupational therapy, wound care, or physical therapy, which are found in a nursing home, following a hospital admission. Stays at these facilities are typically only covered for a short time (up to 100 days).

Assisted living facilities are different from skilled nursing facilities. People in assisted living are often more independent than those in a nursing home but are still provided 24-hour supervision and help with activities like dressing or bathing.

This type of nonmedical care is called custodial care. Medicare doesn’t cover custodial care. However, if you’re staying at an assisted living facility, there may be some things Medicare will still cover, including:

• some necessary or preventive medical or health-related services
• your prescription medications
• wellness or fitness programs
• transportation to doctor’s appointments

Let’s delve a little deeper into what parts of Medicare may cover services that can be associated with your assisted living stay.

Medicare Part A

Part A is hospitalinsurance. It covers the following types of care:

• inpatient hospital stays
• inpatient stays at a mental health facility
• skilled nursing facility stays
• hospice care
• home healthcare

Part A doesn’t cover thecustodial services involved in assisted living.

Medicare Part B

Part B is medical insurance. It covers:

• outpatient care
• medically necessary care
• some preventive care

Although these services maynot be given in an assisted living facility, you’ll likely still need to usethem. In fact, some assisted living facilities can help coordinate medicalservices with your healthcare provider.

Examples of things that arecovered by Part B include:

• certain laboratory tests
• vaccines, such as those for flu and hepatitis B
• screenings for cardiovascular disease
• physical therapy
• cancer screenings, such as those for breast, cervical, or colorectal cancer
• kidney dialysis services and supplies
• diabetes equipment and supplies
• chemotherapy

Medicare Part C

Part C plans are also referred to as Advantage plans. They’re offered by private insurance companies that have been approved by Medicare.

Part C plans include benefits provided in parts A and B and sometimes coverage of additional services, such as vision, hearing, and dental. Cost and coverage can vary by individual plan.

Like Original Medicare (parts A and B), Part C plans don’t cover assisted living. However, they may still cover some services if you live in an assisted living facility that doesn’t include them, such as transportation and fitness or wellness activities.

Medicare Part D

Part D is prescription drug coverage. Like Part C, private insurance companies offer these plans. Coverage and cost can vary by individual plan.

Medicare Part D plans cover approved medications no matter where you live. If you’re staying in an assisted living facility and are taking listed prescription medications, Part D will cover them.

Medigap

You may also see Medigap referred to as supplement insurance. Medigap helps cover things that Original Medicare doesn’t. However, Medigap generally doesn’t cover long-term care, such as assisted living.

So, what can you do if yourself or a loved one may need assisted living care in the coming year? There are some steps you can take to help decide what to do.

Think about healthcare needs

Even though Medicare doesn’tcover assisted living itself, you’ll still need medical care and services. Besure to reviewyour plan options under Medicare before selectinga plan.

Remember that Part C (Advantage) plans may offer additional coverage, such as vision, dental, and hearing. They can also include further benefits, like gym memberships and transport to doctor’s appointments.

If you know that you’ll need prescription drug coverage, choose a Part D plan. In many cases, Part D is included with Part C plans.

Since the specific costs and coverage in parts C and D can be different from plan to plan, it’s important to compare multiple plans before selecting one. This can be done on Medicare’s site.

Determine how to pay for assisted living

Medicare doesn’t cover assisted living, so you’ll need to determine how you’ll pay for it. There are several possible options:

• Out of pocket. When you choose to pay out of pocket, you’ll pay the entire cost of assisted living care yourself.
• Medicaid. This is a joint federal and state program that provides free or low cost healthcare to eligible individuals. Programs and eligibility requirements can differ by state. Learn more by visiting the Medicaid website.
• Long-term care insurance. This is a type of insurance policy that specifically covers long-term care, including custodial care.

Assisted living is a type of long-term care for individuals who require help with their day-to-day activities but don’t need as much assistance or medical care as what’s provided in a skilled nursing facility (nursing home).

Assisted living facilitiescan be found as a stand-alone facility or as part of a nursing home orretirement community complex. Residents often live in their own apartments orrooms and have access to various common areas.

Assisted living is like a bridge between living at home and living in a nursing home. It focuses on combining housing, health monitoring, and assistance with personal care, while residents maintain as much independence as possible.

assisted living services

Services provided in an assisted living facility often include things like:

• 24-hour supervision and monitoring
• assistance with daily activities, like dressing, bathing, or eating
• meals provided in a group dining area
• arrangement of medical or health services for residents
• medication management or reminders
• housekeeping and laundry services
• recreational and wellness activities
• transportation arrangements

It’s estimated that the median annual cost of assisted living is about $38,000. The cost can be higher or lower than this. It can depend on a variety of factors, including:

• location of the facility
• specific facility chosen
• level of service or supervision that’s needed

Since Medicare doesn’t cover assisted living, the costs are often paid out of pocket, through Medicaid, or through long-term care insurance.

Tips for helping a loved one enroll in Medicare

If a loved one is enrolling in Medicare for the coming year, follow these five tips to help them enroll:

• Sign up. Individuals who aren’t already collecting Social Security benefits will need to sign up.
• Be aware of open enrollment. This is from Oct. 15 through Dec. 7 every year. Your loved one can enroll or make changes to their plans during this period.
• Discuss their needs. Everyone’s health and medical needs are different. Have a conversation with your loved one about what these needs are before deciding on a plan.
• Make comparisons. If your loved one is looking at Medicare parts C or D, compare several plans that are offered in their area. This can help them get benefits that meet both their medical and financial needs.
• Give info. The Social Security Administration may request that you provide information about your relationship to your loved one. Additionally, your loved one needs to sign the Medicare application themselves.

Assisted living is a step between living at home and living in a nursing home. It blends medical monitoring and help with daily activities while providing as much independence as possible.

Medicare doesn’t cover assisted living. However, it’s important to remember that Medicare may still cover some medical services that you need, such as outpatient care, prescription drugs, and things like dental and vision.

The costs of assisted living can vary depending on your location and the level of care you need. Assisted living care is often paid for out of pocket, through Medicaid, or through a long-term care insurance policy.

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