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Does Medicare Cover Assisted Living?

Assisted living services can be beneficial for people who don’t have serious medical needs, but do need help with daily activities. Unfortunately, the average cost of assisted living arrangements can be steep. The amount typically paid to cover a private room in a nursing home is around $102,200 per year, according to a 2019 survey by Genworth. Less-expensive options like adult day health care still came to around $19,500 per year.

Will Medicare Pay for Assisted Living for Seniors?

No, in most cases Medicare doesn’t cover costs assisted living costs. Assisted living facilities are places devoted to providing help for various activities like eating, dressing, and bathing. They are meant to be a “home away from home” and aren’t designed to provide more extensive medical care.

Will My State Help Pay for Assisted Living?

Some states do offer an optional Social Security Insurance state supplement. It’s a cash assistance program that helps defray the costs of room and board. You can reach out to your local DHS or SSA office for more information.

In addition, Medicaid may be an option when it comes to getting help with assisted living costs. You may be eligible for Medicaid if you meet the following requirements:

  • You are a U.S. citizen or a permanent resident
  • Fall under the current Medicare income thresholds
  • Have medical expenses that exceed a patient’s income
  • Are a resident of the state that will be administering benefits

Facilities eligible for Medicaid coverage must meet specific requirements as well. The coverage of services depends on the benefits provided by a state’s Medicaid program. They typically offer benefits related to the following services:

  • Personal care (eating, dressing, bathing assistance)
  • Help with household chores
  • Transportation
  • Personal emergency response systems
  • Case management

Does Medicare Cover Services Similar to Assisted Living?

While Medicare doesn’t provide coverage for assisted living or long-term care, it does provide some coverage for post-acute care.  Services must be prescribed as medically necessary by a physician for the treatment of an injury or illness, and include:

  • Part-time or sporadic skilled nursing services
  • Speech, occupational, or physical therapy services administered by a home health agency certified by Medicare
  • Social services related to medical care to help patients get through cultural, psychological, and medical problems arising from an illness
  • Durable medical equipment (DME) and medical supplies like oxygen, hospital beds, and wheelchairs

Medicare also usually covers short stays in a skilled nursing facility. It’s important to keep in mind that for most services Medicare covers, it only pays up to 80%, after deductibles and copays.  

Do Medicare Supplement Plans Cover Assisted Living?

Medicare Supplements are secondary to Medicare, so they only pay if Medicare pays first. This means that a Medicare Supplement won’t cover assisted living costs, because Medicare doesn’t cover them. If Medicare approves long-term care costs such as a stay in a skilled nursing facility, your Medicare Supplement plan will pay its part.

Do Medicare Advantage Plans Cover Assisted Living?

 If you have a Medicare Advantage plan, you’ll need to check your policy for details on your coverage. These plans don’t cover assisted living, but some may offer similar benefits such as adult day care or transportation services.

Ultimately, while Medicare covers a wide range of medically necessary services, it doesn’t offer assisted living benefits. If you or someone you know needs assistance with assisted living costs, you can check to see if you qualify for any of your state’s benefits.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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