Assisted living expenses are costly, so families often wonder whether Medicare will cover them. Unfortunately, Medicare does not cover any assisted living facilities, but it does cover expenses for skilled nursing care.
- Does Medicare Cover Assisted Living?
- Does Medicaid Cover Assisted Living?
- How Much Does Assisted Living Cost?
- Additional Options for Financing Assisted Living Care
Does Medicare Cover Assisted Living?
Assisted living programs include care for older adults who need help with daily activities like cooking, cleaning, and medication management. Medicare does not cover the expenses for housing and custodial care services (help with ADLs), but it will pay for medical expenses accrued while in assisted living for some specific medical services and medical care.
Related: What is Assisted Living?
The expenses covered by Medicare include prescription drugs, doctor’s appointments, medical equipment, and other health care expenses that it covered before moving into an assisted living facility, but medicare does not include long-term care services.
People over age 65 can use the federal health insurance program for several types of coverage. Medicare has four parts: A, B, C, and D. Parts A and B are often referred to collectively as Original Medicare.
Seniors can use Medicare Part A to pay for hospital care, including in-patient hospital services, hospice care, and nursing care at a skilled nursing facility. It also covers prescribed home health care. Medicare taxes cover the expenses, making the care programs free for the majority of beneficiaries.
Note: With Medicare Part A at an approved in-patient facility or home-health care service, your cost is $0 per day for up to 20 days of care, $185.50 coinsurance / copay for days 21 – 100, and all costs for beyond 100 days of care.
Medicare Part B covers outpatient services, especially physician and hospital services, as well as some prescribed home health care and durable medical equipment. Seniors pay about $150 per month for Medicare Part B coverage.
Seniors also get to take advantage of Medicare Part C, the Medicare Advantage Plans that work with private HMOs and PPOs to cover hospital and in-patient services along with benefits like dental and vision coverage.
Medicare Part C coverage can include long-term home care, adult day care, and other community-based services including in-home personal care and some respite care. The Medicare Advantage plans cover prescription drugs, but only from a specific list of providers.
Finally, seniors can use Medicare Part D coverage for prescription drug coverage. This coverage usually costs about $35 per month.
Does Medicaid Cover Assisted Living?
Medicaid is a federally and state funded government program administered by individual states to provide health care and medical services to low income individuals and families. Depending on the state, assisted living may be covered, but nursing home care is typically covered at Medicaid approved nursing facilities due to federal requirements.
While Medicaid is a state administered benefit, the federal government specifies guidelines that each state program must follow. The Medicaid federal guidelines gives states instructions regarding Medicaid benefits and spending, but the states also have significant leeway within the federal guidelines. As such, each state chooses whether to cover assisted living communities. The federal government requires that nursing home residents receive medicaid coverage as part of the federal guidelines.
Despite Medicare having four distinct parts, Medicaid is more complex. Some states have different programs that pay for assisted living expenses such as assisted living facilities and skilled care such as occupational therapy, physical therapy, home health services, or transportation services. They rely on several types of waivers, including 1915c HCBS Waivers, 1115 Demonstration Waivers, and 1915b Managed Care Waivers.
Often, families and individuals looking to Medicaid for assisted living care do not need to worry about the waivers, as the assisted living facilities take care of the waivers and paperwork. Some states offer full Medicaid coverage, also known as State Plan Medicaid, to cover assisted living expenses.
Most states have caps on their Medicaid waivers, giving a limited number of people coverage for assisted living care. States base their State Plan Coverage on need, so they cannot limit enrollment as waivers do.
With waivers, most care plans require the patients to have care that resembles nursing home care, while the State Plans have fewer restrictions for care requirements.
All but six states provide some coverage for assisted living expenses. However, states have varying descriptions for what assisted living actually is. Most include coverage for programs like residential care, supported living, personal care homes, and adult foster care.
While states offer coverage for assisted living expenses, they often limit the payments to personal care services or nursing services. Administrative expenses, as well as homemaker services and recreational services, vary between states. None of the states pay for rental expenses, but they do take steps to control room and board costs.
Find Your State’s Medicaid Details
To understand what your state’s Medicaid pays, coverage benefits, and eligibility requirements, you’ll need to research your state’s Medicaid program.
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
How Much Does Assisted Living Cost?
Assisted living facilities in the United States cost an average of $4,300 per month, but can be significantly more or less depending on the location and level of care required.
Additional Options for Financing Assisted Living Care
As assisted living expenses average around $4,300 per month, seniors often need help paying for it. If they cannot rely on Medicaid and waivers to cover the costs, they have to turn to alternative methods.
Some families turn to state resources that do not involve Medicaid benefits. Families with equity in their homes sometimes use reverse mortgages, home equity lines of credit, or renting out the senior’s house for help with assisted living costs. Other financing options for assisted living include life insurance benefits, assisted living loans, and long-term care insurance which often costs $2,000 – $9,000 per year – if they have it.
Veterans can use two programs to help pay for assisted living expenses:
- Aid and Attendance Benefit
- Veterans’ Direct Care program
Here’s a quick review of common questions regarding Medicare and assisted living:
How much does Medicare pay for assisted living?
Medicare does not pay for assisted living expenses. However, Medicare coverage does include medical expenses like prescription drugs, in-patient care, and doctor’s appointments while receiving assisted living care.
How much does Medicare pay for skilled nursing?
Medicare does cover a limited amount of skilled nursing services. Medicare covers the first twenty days of skilled nursing services. On the 20th day, the patient is responsible for up to $185.50 per day for the services.
Does Medicare pay anything for assisted living?
No. Medicare does not pay for any assisted living expenses but state run Medicaid programs often cover or help with a senior’s long-term care needs.
Is assisted living covered by Medicare or Medicaid?
Medicare does not provide any assisted living coverage, but Medicaid does have some assisted living benefits. The coverage varies by state and by the available waivers in each state.
Does Social Security pay for assisted living?
Social Security benefits do not cover assisted living expenses. Unfortunately, most Social Security benefits are less than the cost of assisted living, so seniors who need help paying for the services have to turn to other options.