Does Medicare pay for assisted living?
Assisted living is expensive. And because many seniors are enrolled in Medicare, a common question is whether Medicare covers assisted living.
Many people are shocked to find out that Medicare doesn’t cover costs for most types of long-term care, including Alzheimer’s and dementia care.
When it does pay, it’s only in a very limited capacity for older adults with recoverable conditions on a short-term basis.
We explain why Medicare doesn’t pay for assisted living, what type of long-term care Medicare does cover, and what types of long-term care Medicare Advantage covers.
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No, Medicare doesn’t pay for assisted living
The answer is no. Medicare doesn’t cover the cost of assisted living facilities or any other long-term residential care, like nursing homes or memory care.
That’s because Medicare doesn’t cover the cost of room and board or non-skilled assistance with daily activities (personal care), which make up the majority of assisted living care.
However, whether your older adult lives in their home or in an assisted living facility, Medicare will continue to cover prescription medications and/or other medical services that would normally have been covered by your specific plan.
What type of long-term care does Medicare cover?
Long-term care services for short-term stays may be covered by Medicare, but only under specific circumstances.
If a doctor determines that an older adult needs specialized nursing or rehabilitation after an inpatient hospital stay lasting at least three days, original Medicare will pay 100% of the cost of care up to 20 days at a Medicare-certified skilled nursing facility and approximately 80% of the cost up to 80 more days.
This coverage begins only if your older adult was formally admitted to a hospital for three days or more, not if they were there under observation.
And this coverage doesn’t apply to assisted living facilities, which don’t provide skilled nursing or intensive medical care.
Does Medicare Advantage pay for assisted living?
Medicare Advantage is required to cover at least as much as Original Medicare.
But Medicare Advantage doesn’t cover assisted living or any other long-term residential care.
Medicare Advantage are private insurance plans contracted through the government, so each policy has its own specific benefits.
What Medicare Advantage typically will cover are eligible medical expenses like prescriptions, surgery, doctor’s appointments, screenings and equipment whether your older adult lives in their home or moves to an assisted living facility.
Medicare Advantage plans may also include additional benefits like transportation to medical appointments, vision and hearing coverage, and gym memberships.
Also, just like Original Medicare, costs may be covered if your older adult needs short-term care at a skilled nursing facility immediately following a hospitalization.
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By DailyCaring Editorial Team
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