Does medicare cover assisted living?

Assisted Living Communities Medicare does not cover any cost of assisted living. You will pay most of the medical costs incurred while the older person is in assisted living, but you will not pay anything for custodial care (personal care) or the cost of room and board for assisted living. Some Medicare Advantage plans can pay for personal care assistance for people who reside in assisted living or memory care facilities, but they don't contribute to the cost of room and board. Medicare doesn't cover costs associated with living in an assisted living community (also known as custodial care).

This type of care “is not considered medically necessary or a matter of health insurance,” says Gabrielle Juliano-Villani, owner of Colorado In-Home Counseling, which serves seniors and disabled adults. Medicare does not cover the cost of residing in assisted living communities, which are facilities that provide housing and custodial services such as laundry, cooking, medication management, and other activities of daily living for older adults or people living with a disability who are eligible for Medicare. Some Medicare Advantage plans may include services such as home modifications, adult day care, activities of daily living, and transportation. If you apply for retirement or disability benefits from the Social Security Administration, that application will also automatically serve as your Medicare application.

If you need help with daily activities, you can look for local community programs, state programs, or other types of funding. Although Medicare hospice doesn't usually pay for room and board, it does cover medical expenses, prescription drugs, and housekeeping services, which Medicare usually doesn't pay. These facilities are equipped to provide more health care than assisted living communities, when certain requirements are met. Before choosing an assisted living community, make sure you confirm that it is properly licensed and reputable.

The older adult must be “confined”, which means that he cannot leave the home without the help of another person. According to the National Center for Assisted Living, assisted living communities offer a residential environment that provides a range of services aimed at adapting to the changing needs and preferences of their residents as they age. While some Medicare Advantage plans include benefits related to home care services, they generally don't cover assisted living or any other long-term custodial care. They do not need the specialized medical care provided in a nursing home, but rather the general assistance and personal care that they might otherwise lose while living independently.

In addition, some MA plans now offer long-term services at home and in the community, such as adult day care, home self-care assistance, and respite care, under certain conditions. In Home CareMedicare will cover skilled nursing care at home for a limited period of time, but not non-medical care. According to the National Center for Assisted Living, there are more than 800,000 Americans residing in assisted living facilities. The short answer is no: Medicare doesn't cover your living expenses in an assisted living facility.

Daphne Loup
Daphne Loup

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