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 services Medicare will still cover that can be associated with your assisted living stay, such as:

• Medicare Part A: This can cover stays in hospitals, mental health facilities, or skilled nursing facilities. It also covered hospice care and home healthcare. While these things are not related to assisted living, you may still require them.
• Medicare Part B: Part B can also cover some medical services that people in assisted living might still require, such as lab tests or certain screenings. In fact, some assisted living facilities can help coordinate medical services with your healthcare professional.
• Part C (Medicare Advantage): These plans 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.
• Part D: This is prescription drug coverage. If you’re staying in an assisted living facility and are taking listed prescription medications, Part D will cover them.
• Medigap: Often referred to as supplement insurance, it doesn’t generally cover long-term care, such as assisted living, but it can help you pay the remaining cost for other services after coverage by the other parts.

It’s estimated that the median annual cost of assisted living is about $38,000. According to the National Council on Aging (NORC), the average monthly cost for a private room in an assisted living facility is about $4,500.

That said, 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

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

With Medicare, it’s a good idea to keep in mind a few types of care in addition to custodial care that wouldn’t be covered. These include:

• any procedures or medical supplies deemed not medically necessary, such as excessive or unrelated diagnostic tests or services exceeding the approved length of stay.
• medical services or supplies received outside of the U.S.
• medical services or supplies needed as a result of war
• comfort items such as beauty services
• certain routine exams such as physicals or eye exams

Note, however, that all of these limitations have exceptions. You can check the Centers for Medicare & Medicaid’s booklet on items & services not covered under Medicare for more information.

Assisted living is a step between living at home and living in a nursing home. It blends medical monitoring and helps 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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