Medicare does not cover assisted living, but it may cover skilled nursing.
By 2030, 1 in every 5 people in the United States will have reached retirement age.
In this article, learn whether Medicare covers assisted living expenses, skilled nursing care, and in-home care, as well as alternative ways to help cover the costs.
Medicare does not cover the costs of assisted living facilities or communities.
These provide what is sometimes called custodial care: help with daily activities such as bathing, housekeeping, and laundry. In addition, security services and social activities are often available.
The size of a facility can vary — it may offer residence in small detached houses or apartments.
An assisted living facility, sometimes known as a board or care home, also provides meals, and staff members are available around the clock. Though medical care is not usually provided in these facilities, the services can vary.
The overall aim is to help people live as independently as possible.
Medicare may pay for a short-term stay in a skilled nursing facility. Covered costs include:
- semiprivate rooms
- skilled care
- required medication
- medical supplies and equipment
- ambulance transport
- nutrition counseling
- physical, occupational, and speech therapy
Skilled nursing facilities are focused on providing medical care. Nurses are available at any time of the day or night.
Also, staff members provide three meals a day, alongside help with personal care and rehabilitation.
The goal is to help a person become well enough to return home and live independently.
To be eligible for skilled nursing benefits, an individual must:
- have Medicare Part A coverage
- have been admitted to a hospital for at least 3 days before entering the nursing facility or have a medical condition that began during the stay
- be admitted to a Medicare-certified facility within 30 days
- need skilled care, such as nursing, physical therapy, occupational therapy, or other qualifying services
Once eligibility has been established, Medicare Part A pays for some costs of the first 100 days, as follows:
- The first 20 days are 100% covered.
- Days 21–100 are subject to a copayment of $176.
- Once a person meets this copayment, Medicare covers the remaining costs in full.
- They do not cover the costs of day 101 onward.
Adult day care facilities provide varying services during the day throughout the working week. Some centers focus more on activities and others on specialized care.
One insurance company estimates that adult day care costs $1,625 per month.
Certain Medicare Advantage plans provide some adult day care coverage. Medicare parts A and B do not cover adult day care.
There can be a wide range of benefits to receiving care services at home, including the fact that it is usually less expensive than residing in an assisted living facility.
At home, a person can receive personal care, medical attention from a skilled practitioner, or a combination. Skilled care may involve shots, wound care, or health education.
For a person to be eligible for coverage, a doctor must certify that the care is medically necessary and that the person cannot leave their home.
In-home care services could include:
- part-time skilled nursingcare
- physical therapy
- occupational therapy
- speech therapy
- medical social services
- part-time home health aideservices
However, neither Medicare parts A or B pay for 24-hour care at home or meal delivery.
People with Alzheimer’s disease or other forms of dementia require varying types of services.
Some may benefit most from adult day care, others from in-home care, and still others from residing in assisted living or skilled nursing facilities.
A person with Alzheimer’s disease or another type of dementia receives the same coverage as others using Medicare.
Medicare usually does not cover long-term nursing care, but some Advantage plans may provide coverage for this or custodial care.
Insurance providers can give more information about the dementia care coverage that specific Advantage plans offer.
Medicare pays 100% of the costs of hospice care. However, a copayment of $5 for prescribed pain relief medication sometimes applies.
Medicare does not pay for room and board when someone receives hospice care at home.
Hospice care is for people who are terminally ill. To qualify, a doctor must have confirmed that treatment would not be effective and that the person is not expected to live for more than 6 months.
Some situations can affect Medicare coverage. These include:
When a doctor is deciding whether to admit a person to a hospital, they may consider the person to be an outpatient.
This time period does not count toward the criterion for skilled nursing care coverage that requires the person to have spent the last 3 days in a hospital.
If a person refuses care at a skilled nursing facility, they may lose coverage.
Care is stopped or a person leaves
If a person stops receiving care or leaves the skilled nursing facility, it affects their Medicare coverage.
Various loans and policies can help people pay for services that Medicare does not cover, including:
- Life insurance: Some life insurance policies help pay for long-term care services.
- Reverse mortgage: This type of home equity loan lets a homeowner take cash from their home without selling it.
- Long-term care insurance: Though only 5% of older adults in the U.S. have long-term care insurance, it can help pay for assisted living.
- Assisted living loan: This is a short-term measure to help cover the costs of assisted living. For example, if a person is selling their home but unsure how long it will take, an assisted living loan may help.
- Medicaid: A person may qualify for Medicaid if they have a low income and do not have assets, such as a home. Medicaid can help cover assisted living costs if a person qualifies for skilled nursing care but chooses assisted living instead.
Assisted living facilities provide support with daily personal care. Neither Medicare parts A or B pay for this, but some Medicare Advantage Plans do.
If a person needs skilled nursing care and meets Medicare’s requirements, coverage is available for the first 100 days.
Long-term care insurance, life insurance, and reverse mortgages can help pay for these services when Medicare does not.