Does Medicare Pay For Assisted Living?
Original Medicare does not cover the costs associated with assisted living facilities or other types of long-term residential care, such as nursing homes and memory care facilities.
These types of care generally require alternative payment methods, such as long-term care insurance or personal funds, to meet the financial obligations. It is crucial to carefully plan for these potential expenses and explore various financial options to ensure sufficient support for your long-term care requirements.
What Does Medicare Cover?
Although Medicare doesn’t cover assisted living, Part A provides coverage for skilled nursing care in select short-term settings. However, this coverage is limited to a maximum of 100 days.
In specific circumstances, Medicare Part A can temporarily assist with the cost of skilled nursing care if all the necessary conditions for eligibility are met.
To qualify for Medicare Part A coverage for skilled nursing care, the following conditions must be satisfied:
- You must be enrolled in Medicare Part A and have days remaining in your Medicare benefit period.
- You must have had a qualifying hospital stay.
- Your physician must establish that you require skilled care daily.
- The Skilled Nursing Facility (SNF) where you receive your skilled services must be Medicare-certified.
- The skilled services you require must be for a medical condition that either originated during your qualifying three-day inpatient hospital stay (even if it wasn’t the primary cause of your hospitalization) or developed while receiving care in the SNF for a hospital-related medical condition. An example of this could be contracting an infection that necessitates intravenous antibiotics while you are receiving care in the SNF.
What Does Medicare Not Cover?
Medicare typically does not cover the following services often associated with assisted living:
- Personal care (custodial care), such as help with in-home eating, bathing, and dressing or other activities of daily living.
- Assisted Living Coverage
- Nursing home Care.
- 24-hour supervision.
Covering these services is the financial responsibility of the individual or their family. However, some states may offer assistance with personal care and other assisted living costs through Medicaid’s home and community-based waiver programs.
Other Options for Paying for Assisted Living
If Medicare does not cover assisted living costs, other options are available for this type of care. Medicaid is a government program that provides medical assistance to low-income individuals and may cover the cost of assisted living for eligible seniors. Veterans may also qualify for VA’s Aid and Attendance program assistance.
Seniors can also pay for assisted living out of pocket or through long-term care insurance. Long-term care insurance policies vary, so reading the fine print and understanding what is covered is essential.
While Medicare coverage does not typically help with the cost of assisted living facilities, other options are available for seniors who need this type of care. Medicaid, long-term care insurance, or veterans benefits programs are just a few alternatives that seniors and their families can explore. Researching and understanding all the options available when considering moving to an assisted living facility is essential.
How many days will Medicare cover all costs for care in a skilled nursing facility?
Medicare will pay 100% of the covered care costs in a skilled nursing facility for up to 100 days per benefit period. After the 100th day, Medicare may cover additional cost-sharing amounts, depending on individual circumstances.