Does Medicare Cover Assisted Living?
Key takeaways:
Original Medicare (Parts A and B) typically does not include coverage for nonmedical services, such as long-term care facilities like assisted living.
If you have original Medicare, it may cover some medically necessary services at an assisted living facility, like physical therapy. But Medicare will not cover costs related to room and board.
Medicare Advantage plans offer the same basic coverage as original Medicare, plus additional coverage, which may include assisted living expenses.
Table of contents
As you age, you may need help performing daily tasks such as bathing or getting dressed. A study showed that 1 in 5 adults in the U.S. over age 85 needs or receives help with everyday tasks. An assisted living facility may be an option for you if living on your own becomes a challenge. These facilities, which are different from nursing homes, provide older adults with the personalized care they need and allow them to maintain a private living space.
Depending on where you live, assisted living can cost more than $5,000 per month. If you have Medicare, it’s important to understand what your plan covers and how much money you may have to pay out of pocket.
What is assisted living?
Assisted living is long-term housing that provides care for people with disabilities or those who need help with activities of daily living (ADLs). Places that provide assisted living are also referred to as adult, personal, or residential care facilities.
Many residents of assisted living facilities are older adults with medical conditions such as:
Bladder or bowel incontinence
Assisted living facilities do not provide the same medical care as nursing homes. But they offer more around-the-clock assistance than family or home health services can give.
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Does Medicare cover assisted living?
Medicare is a government health insurance program that helps individuals pay for the cost of medically necessary services. This includes an array of things, including visits with healthcare professionals, MRIs, and hip replacement surgery.
But Medicare and Medigap (supplemental insurance) do not pay for long-term care or assisted living for the sole purpose of helping with everyday tasks. If you have Medicare Part D, your prescription medications may be covered at a long-term care pharmacy that accepts your plan.
When you have a Medicare Advantage (Part C) plan, you may have additional coverage for assisted living expenses compared with original Medicare or Medigap. These plans are available through private insurers. They include the same benefits as Medicare Part A and B, plus extra services like personal care. But costs and coverage options vary. It’s important to check with Medicare Advantage (and original Medicare) insurance professionals to see what services are covered for your needs.
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What assisted living services does Medicare cover?
Original Medicare (Part A and B) generally does not cover nonmedical services, like personal care, at an assisted living facility. But there are a few exceptions. Medicare Part A (hospital insurance) may pay for some short-term, medically necessary services, such as:
Limited skilled nursing care, like wound care
Medical equipment and supplies
Transportation to and from healthcare appointments
Certain preventive health services
Original Medicare may also cover some associated costs that come with assisted living, like:
Cognitive assessments
Care planning
Hospitalization
Medicare Advantage will pay for the same limited services that original Medicare covers. Some plans may also offer additional coverage for things like:
Does Medicaid cover assisted living costs?
Yes, Medicaid can help with some assisted living costs. Whether you can receive coverage depends on your state and the level of care you need. Some states offer waivers for home- and community-based services. Waivers can help pay for services that allow for you to live in an assisted living facility instead of a nursing home.
If your state offers these waivers, you might qualify for support to pay for the following services in an assisted living facility:
Personal care assistance
Transportation for medical visits
How do you qualify for assisted living coverage under Medicare?
Medicare Part A may cover some of the medical care you receive in an assisted living facility for a limited time if:
You have Part A and have days left in your benefit period.
You have had a qualifying hospital stay.
A healthcare professional thinks you need daily skilled care.
The assisted living facility where you will receive care is certified by Medicare.
You may also qualify for coverage under Part A if you need skilled care for a medical condition that:
Is related to a qualifying hospital stay, even if it wasn’t the reason you were admitted to the hospital.
Is a hospital-related condition, such as an infection that requires IV antibiotics, that is being treated in a skilled nursing facility.
Is an ongoing condition treated during your hospital stay or a new condition that started while receiving care at a skilled nursing facility.
Is necessary to improve, maintain, or prevent your condition from worsening.
Be aware that Medicare Part A pays for skilled nursing care for only 100 days.
How much does assisted living cost?
According to the 2023 Genworth Cost of Care Survey, the median cost of assisted living in the U.S. is about $5,350 per month, or $64,200 a year. A private room in a nursing home costs about $320 per day, while home health aide services cost around $33 per hour.
The total cost you pay for assisted living can vary depending on the following factors:
How many hours of care you need each week
What time of day you need care
Where you live
Which facility or provider you choose
Additional services that may be required based on your health condition
Assisted living facilities have different levels of care available. The more independent you are, the lower your costs will be.
What assisted living expenses should you consider?
Depending on the facility, here are some assisted living expenses you may be responsible for:
Monthly rent
Services such as help with ADLs, medication management, and nursing care
Special meal plans
Activities and events
Move-in fees
Housekeeping
Laundry services
How to pay for assisted living expenses
There are many ways to pay for long-term care at an assisted living facility. Your payment method will depend on your financial situation and the type of care you need.
Most health insurance and disability insurance policies limit coverage for or do not cover assisted living at all. That leaves many people and their families trying to cover the costs themselves. You might consider the following options when determining how to pay for assisted living:
An annuity
Investments
Personal savings
Retirement funds
Social Security Administration programs
Frequently asked questions
Yes, Social Security can provide some financial help for assisted living expenses in most states if you meet eligibility requirements. But it typically won’t cover the total cost, so you’ll likely need help from other financial resources to pay the rest.
Veterans who qualify may get help paying for assisted living costs through the Veterans Administration (VA). The VA runs some assisted living facilities and approves others. Though the VA covers some assisted living expenses if you enroll in VA health care, you might have to pay a copay for certain services. For any services that the VA does not cover, you may be able to use Medicaid, Medicare, or private insurance to help cover those costs.
The bottom line
As you get older, it becomes important to maintain independence. When you need help with everyday tasks, an assisted living facility may be a good option. The cost of assisted living depends on various factors, such as the type of care you receive, how long you need care, and where you live.
Original Medicare and Medigap (supplemental insurance) do not cover personal care at an assisted living facility, but they may pay for medically necessary services there. A Medicare Advantage plan may offer extra coverage for services like personal care. But since Medicare generally won’t cover your costs, it’s a good idea to plan ahead and identify alternative ways to pay for assisted living.
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References
American Seniors Housing Association. (n.d.). Learn about assisted living.
Centers for Medicare & Medicaid Services. (2024). Who pays for LTSS?
Centers for Medicare & Medicaid Services. (2024). Your guide to choosing a nursing home or other long-term services and supports.
Edemekong, P. F., et al. (2023). Activities of daily living. StatPearls.
Genworth Financial. (2024). Genworth cost of care survey 2023.
Medicare.gov. (n.d.). Cognitive assessment & care plan services. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Long-term care. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Skilled nursing facility care. Centers for Medicare & Medicaid Services.
MedlinePlus. (2023) Assisted living.
National Council on Aging. (2023). Does Medicare pay for assisted living?
National Institute on Aging. (2023). Paying for long-term care. National Institutes of Health.
U.S. Department of Veterans Affairs. (2024). Nursing homes, assisted living, and home health care.
