Does Medicare Pay for Assisted Living?

Assisted living facilities support older adults with daily living while fostering their independence. Individuals who do not require round-the-clock nursing but need help with everyday activities like bathing, housekeeping, medications, and meal preparation can benefit from assisted living.

Some seniors choose to move into assisted living following a frightening event, such as a fall. They want to live autonomously but may feel unsafe in their homes.

Averaging between $4,500 to $15,000 per month, assisted living can be expensive. Those considering assisted living might wonder whether Medicare, a federal health insurance program for qualifying adults aged 65 or over, will cover the cost.

Traditional Medicare covers only certain health services to those residing in an assisted living facility. Meanwhile, some Medicare Advantage programs may only pay for services that help people remain in their homes.

Does Traditional Medicare Cover Assisted Living?

In short, no. While traditional Medicare supports older adults’ medical needs, it does not apply to most assisted living expenses. Assisted living facilities help residents with everyday, nonmedical tasks, which Medicare typically does not include.

Medicare Part A insures people for hospital stays and up to 100 days in a skilled nursing facility. Skilled nursing facilities provide 24-7, short-term nursing care. Because they deliver medical care, they are distinct from assisted living facilities, which offer custodial or daily life care.

Medicare Part B pays for medical fees for outpatient care, and Part D covers prescription drug costs. Most assisted living expenses do not fall under Medicare Part A, B, or D.

However, traditional Medicare may cover specific medical costs for people in assisted living. Expenses Medicare may cover include:

• Physical therapy

• Specific health services like changing sterile dressings

• Preventative health services like vaccinations

• Health care transportation

Does Medicare Advantage Pay for Assisted Living?

Private insurance companies that contract with traditional Medicare sell Medicare Advantage plans. Like original Medicare, these plans typically do not cover monthly assisted living bills.

Certain Medicare Advantage plans may offer supplemental home care benefits that help people continue living independently, albeit in their own homes rather than a designated facility.

The services available through select Medicare Advantage programs may include home modifications like wheelchair ramps and bathroom safety grab bars; in-home assistance with daily tasks; and transportation to the hospital and the pharmacy. Adult daycare is also available through some Medicare Advantage plans.

Seniors looking to live on their own might consider enrolling in a plan that includes services that support autonomy. Many programs are available, and the coverage that is open to you depends on where you live. The terms of Medicare Advantage plans vary. Review your plan options and speak with an attorney before deciding whether to enroll in a Medicare Advantage program.

Does Medicaid Pay for Assisted Living?

Unlike Medicare, Medicaid generally will pay for some of the costs of assisted living. Medicaid is a joint federal-state health insurance program for low-income people, including older adults. Although it does not cover room and board for assisted living, it may help pay for personal care services, on-site therapy services, and medication management.

Before deciding whether to move into an assisted living facility, speak to an elder law attorney. An attorney who understands Medicare and Medicaid can advocate for you and help you plan for your future. Please feel free to reach out to Sowards Law Firm at (408) 371-6000 or info@SowardsLawFirm.com if you have any questions or concerns.