Does Medicare Cover Assisted Living?
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Medicare coverage won't pay for you to stay in an assisted living facility. That's because Medicare doesn't cover costs associated with everyday living like dressing, bathing and cleaning.
Several government programs including Medicare, Medicaid and PACE will pay for some medical costs that you may have while staying at an assisted living facility. However, coverage varies from state to state.
Does Medicare pay for assisted living?
Medicare does not pay for assisted living. However, it may pay for related services under certain circumstances.
Assisted living is specifically a type of residential care where you live in a facility and receive help with everyday tasks like grooming, cooking and cleaning. However, you still have an independent lifestyle since the level of care isn't as high as what you'd find at a nursing home.
If you're in the market for long-term care insurance, it's a good idea to buy it when you're in your early-to-mid-60s if you're single and at 55 if you're married to get the best value for your money. You're more likely to be rejected if you apply when you're older.
You might expect Medicare to cover some or all of these costs since the government program provides expansive health care coverage to most elderly Americans. However, Medicare only covers medically necessary care, and the majority of services performed at an assisted living facility don't fall in that category.
For example, an assisted living facility may have staff to help with routine tasks like dressing, preparing meals or doing the laundry, while Medicare would pay for you to visit the doctor or stay at a hospital.
Ways to pay for your assisted living stay
You should consider one of the following options if you're concerned about paying for assisted living.
Long-term care insurance
Long-term care insurance will help you pay to stay at an assisted living facility, retirement home or adult daycare. It also provides reimbursement for in-home care.
Most long-term care insurance policies cover a certain dollar amount per day with limitations on the total number of days. Other policies may support you up to a total lifetime sum, which would cover several years of assisted living.
Some life insurance policies let you add a long-term care rider, or extra coverage, for long-term care assistance. However, a rider may offer less flexibility compared to a stand-alone plan, and not all forms of life insurance offer this option.
Typically, if you want long-term care insurance, it's a good idea to buy in your early-to-mid-60s to get the best deal. The older you get, the more likely you'll be denied coverage.
Veterans Affairs (VA) coverage
VA health care pays for certain types of long-term care, such as assisted living facilities, nursing homes, home health aides and caregiver support. You must already be signed up for VA health care, and you need a doctor's approval before accessing VA assistance for any type of long-term care help.
Medicaid
Medicaid will pay for some, but usually not all, of the costs associated with assisted living. Keep in mind that Medicaid coverage varies by area with some states providing greater coverage than others.
For example, Medi-Cal, California's Medicaid program, will pay for you to stay in an assisted living facility if you qualify for its assisted living waiver program. Other states may not offer this level of coverage.
In general, Medicaid will pay for some medical services, such as hospice and skilled nursing care either at home or in a facility. However, it usually won't pay for food, facility fees and help with everyday chores like getting dressed, cleaning or cooking.
What are the differences between assisted living facilities and skilled nursing facilities?
Assisted living programs are run in a residential setting and focus mostly on providing custodial care. Custodial care refers to a range of daily activities, such as cooking, cleaning, dressing, eating and using the bathroom.
Medicare will pay for home health care if you qualify with a serious medical condition.
You might enroll in an assisted living program if you're not suffering from a major illness or injury but you need help with basic tasks. Assisted living programs let seniors maintain a semi-independent lifestyle.
By contrast, skilled nursing facilities focus on providing medically necessary care. You might go to a skilled nursing facility after suffering a bad accident or if you're recovering from a serious disease.
Other Medicare programs
Medicare Supplement and Medicare Part D add to Original Medicare (Parts A and B), while Medicare Advantage plans replace Medicare Parts A, B and oftentimes D. Both kinds of plans are sold by private companies.
Medicare Supplement (Medigap) plans can pay for some care if you're at an assisted living facility. But, they will not pay for your rent payments or your custodial care, such as help with getting dressed or cleaning.
Medicare Advantage (Part C) will be similar to Medigap because it will likely offer extra coverage, like vision, dental and hearing care, but still won't pay for you to live in assisted living.
You'll be able to expand your Medicare coverage if you purchase a Medicare Advantage or Medicare Supplement plan, but neither will likely pay for assisted living.
Part D coverage can pay for your prescriptions while you're staying in assisted living. But it won't pay for anything else.
Medicare benefits for seniors
While Medicare doesn't pay for assisted living facility costs, it does pay for several similar services.
- Home-based care: Medicare will pay for a nurse or another health care professional to visit you at your home for no more than eight hours a day up to 28 hours a week (35 in some cases) if you need medical care. Unlike a home health aide, a nurse performing home-based care will not assist with tasks associated with day-to-day living like grooming, dressing or cleaning.
- Skilled nursing facility: A skilled nursing facility provides inpatient care on an ongoing basis. Medicare requires a doctor's referral in connection with a specific injury or disease before coverage kicks in. Medicare pays for all of your costs for the first 20 days, and part of your costs for the next 80 days. Coverage ends after 100 days within a single benefits period.
- PACE: The Program of All-Inclusive Care for the Elderly (PACE) is a government program that helps those age 55 and older pay for their health care needs. Although it won't pay for assisted living care, it will pay for some medical costs including adult day care, nursing home care and meals.
- Hospice care: Medicare may cover up to 100% of hospice-related costs if you're diagnosed with a terminal illness.
Frequently asked questions
Does Medicare pay for assisted living?
No, Medicare does not pay for assisted living. Medicaid, a government program that provides health coverage to low-income individuals, may pay for some or all of your assisted living bills depending on where you live.
You can sign up for Medicare and Medicaid if you meet the qualifications for both programs.
How long will Medicare pay for home health care?
Medicare will pay for a nurse or aide to provide you with medical assistance in your home for up to 28 hours a week (but no more than eight hours a day) if you receive a doctor's approval. Special cases may be eligible for up to 35 hours of home health care a week.
How is most assisted living care usually paid for?
Long-term care insurance is a common way to pay for assisted living care. Medicaid is another popular option, and some individuals pay out of pocket, although the high cost of assisted living care makes this difficult for most Americans.
Sources and methodology
Coverage details for assisted living benefits were compiled from several government sources, including Medicare.gov for Medicare, Medicaid and PACE. We consulted the official website of the Department of Veterans Affairs for VA benefits.
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