Assisted living is expensive, and because many seniors are enrolled in Medicare, a common question is whether Medicare covers assisted living. Plenty of 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 minimal capacity for older adults with recoverable conditions on a short-term basis. This piece explains why Medicare doesn’t pay for assisted living and what types of long-term care Medicare Advantage covers.
Does Medicare Pay For Assisted Living?
The answer is no. Medicare doesn’t cover the cost of assisted living facilities or other long-term residential care, such as 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), comprising most assisted living care.
However, whether your older adult lives in their home or an assisted living facility, Medicare will continue to cover prescription medications and/or other medical services that your specific plan would have typically covered.
Does Medicare Cover Other Types of Long-Term Care?
Medicare may cover long-term care services for short-term stays, but only under specific circumstances.
Suppose a doctor determines that an older adult needs specialized nursing or rehabilitation after an inpatient hospital stay lasting at least three days. In that case, 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.
However, Medicare Advantage doesn’t cover assisted living or long-term residential care.
Medicare Advantage is a private insurance plan contracted through the government, so each policy has specific benefits.
Medicare Advantage typically covers eligible medical expenses like prescriptions, surgery, doctor’s appointments, screenings, and equipment, whether an 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.
Recommended for you:
- 7 Senior Housing Options: Which One Works Best?
- How to Pay for Assisted Living: 6 Options
- When to Move to Assisted Living? Advice From a Social Worker
About the Author
Connie Chow
Connie was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also knows how important support is — especially in the form of practical solutions, valuable resources, and self-care tips.
