Does Medicare cover assisted living?

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Dear Connie,

I’m helping my Mom choose her Medicare plan this year, and I am looking at planning for her long-term care. Because assisted living or nursing home care is likely in her future, I’m wondering, does Medicare cover assisted living?

Thanks,
Jennifer from Grand Prairie, Texas

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Dear Jennifer,

It is good that you are helping your Mom navigate Medicare plans and thinking about her future.

Finding the right plan and preparing for the future when things are uncertain can be stressful and confusing. And if assisted living or nursing home care is likely, it is understandable that you want her to be comfortable and covered wherever she is.

Original Medicare does not typically cover assisted living or long-term care. Even if she moves to an assisted living or nursing home care facility, she still needs Medicare to cover doctor services and hospital care. Family members may pay out-of-pocket to cover the costs or get long-term care insurance for assisted living or nursing home care. A Medicare Advantage plan may be another viable option.

If you qualify for Medicaid, Medicaid waivers can help pay for assisted living or a nursing home. You can visit your state’s Medicaid office to determine eligibility for Medicaid. You can also go to Medicaid.gov to learn more about the available Medicaid programs in your area.

Finding the right senior living option will depend on the type of care your Mom will need. These are the two most common options:

1. Adult daycare programs help seniors socialize with peers and stay mentally active. They also assist caregivers who may need to balance their needs with their day-to-day responsibilities.
2. Residential care refers to long-term homes where seniors live with other seniors in non-medical facilities:

• • Independent living facilities are housing arrangements for older adults who need limited or no assistance managing their daily activities. These facilities accommodate aging adults and allow seniors to live independently but access amenities and activities that enable them to connect with others.
  • Assisted living facilities are similar to independent living facilities. Still, they are for seniors who may need more assistance with activities of daily living, such as managing medications, using the bathroom, or grooming.
  • Nursing homes are for seniors who need full-time assistance and care to help complete regular activities.
  • Memory care facilities are part of assisted living facilities and nursing homes designated for people with dementia. They have facility features that keep residents safe from wandering off and staff specifically trained to care for people with dementia.

Agent tip:

“Medicare Part A covers skilled nursing facilities, while some Medicare Advantage plans cover nursing home care. You can search for Medicare Advantage plan providers that offer this extra benefit.“

Medicare Part A covers skilled nursing facilities, which provide more extensive medical care than assisted living communities. Skilled nursing facilities offer medical care for recovering after an illness or injury and rehabilitative services such as physical, occupational, and speech therapy.

An individual may qualify for Medicare coverage at a skilled nursing facility if specific criteria are met:

• The individual has a medical condition that needs skilled nursing care.
• A doctor determines the person needs skilled care under the supervision of skilled nursing or therapy staff.
• The services are used to actively treat a specific illness, injury, or health condition.

Medicare Advantage plans may also cover nursing home care if they have a contract with the nursing home. Before transitioning to a nursing home, you can ask your plan provider about nursing home care.

Before transitioning to an assisted living facility or nursing home, check if it is licensed and reputable. Assistedliving.org has a directory tool for comparing and reviewing the facilities.

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• Compare all major plans and carriers
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Connie Health has a plan comparison tool that sorts your numerous plan options. Enter your doctors, prescription medications, and desired benefits, and our technology will compare available plans tailored to your needs–quickly narrowing your choices.

While it may be worrisome, there are many available resources and options for you and your mom to find a facility that works for both of you and pay for long-term care costs. I wish you both the best. Should you have any additional questions or need help, please get in touch with us at (623) 223-8884

Frequently Asked Questions

Does Medicare pay for assisted living for dementia?

No. Original Medicare Part A and Part B do not pay for assisted living, even for someone with dementia.

If you or a loved one needs to be in a full-time residential memory care facility, the financial responsibility would not be covered by Original Medicare. Family members typically pay out-of-pocket to cover the costs of memory care, averaging $6,200 per month and $74,400 per year.

• Help with costs: If qualifications are met, Medicaid can help pay for memory care. You can visit your state’s local Medicaid office or Medicaid.gov to learn about eligibility. Long-term care insurance can help pay for the cost of assisted living or nursing home care should it be needed.
• Skilled nursing: Medicare Part A will cover some care at a skilled nursing facility. Skilled nursing facilities offer medical care for recovering after an illness or injury and rehabilitative services such as physical, occupational, and speech therapy.
• Prescription drugs: You can also have prescription drug coverage through a Medicare Part D or Medicare Advantage Prescription Drug plan.
• Hospice care: For late-stage dementia and Alzheimer’s patients, Original Medicare offers a hospice benefit.

Some Medicare Advantage plans cover long-term care costs, such as personal care and assistance. When choosing a Medicare Advantage plan, ensure that you review the Evidence of Coverage (EOC) to learn if the memory care products and services needed are covered.

Have questions about Medicare plan coverage? Call (623) 223-8884 to speak with a licensed Connie Health agent in your area. We can help you review your current benefits and find the coverage you need.

Will Medicare pay for assisted living?

Original Medicare does not typically cover the costs of assisted living. While Medicare is a valuable resource for seniors, it is primarily designed to cover medical services and treatments, such as doctor visits, hospital stays, and prescriptions. On the other hand, assisted living focuses on providing non-medical services like help with daily activities, housekeeping, and meal preparation—which are generally outside Medicare’s scope.

However, Medicare Part A covers certain healthcare services you might receive while living in an assisted living facility, such as skilled nursing care, physical therapy, or medical equipment. It’s also worth exploring other options, such as Medicaid or long-term care insurance, which may provide financial assistance for assisted living.

Some Medicare Advantage plans cover long-term care costs, such as personal care and assistance. When choosing a Medicare Advantage plan, review the Evidence of Coverage (EOC) to learn if assisted living is covered.

If you have any questions or need guidance navigating your Medicare options, a local licensed Connie Health agent can help. Call (623) 223-8884 to review your current plan for assisted living coverage.