Does Medicare Cover Assisted Living?

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The short answer: No, Medicare doesn’t cover the cost of residing in an assisted living community.

Medicare generally doesn’t cover the cost of residing in assisted living communities, which are facilities that offer housing and custodial services — such as laundry, cooking and managing medications — for older adults. It does however cover skilled nursing facilities that are better equipped to provide medical care than assisted living communities.

Medicare will cover you for your prescriptions, surgery, screenings, and equipment if you move into an assisted living facility.

What is the difference between an assisted living community and a skilled nursing facility?

Assisted living communities are not the same as skilled nursing facilities or nursing homes, which are located in clinical settings.

Nursing homes can provide a higher level of care and may be eligible to receive Medicare coverage in some cases. The majority of assisted living communities provide custodial care. This includes bathing, dressing, eating, meal preparation and using the bathroom. Custodial care is not covered by Original Medicare (Part A or Part B), unless it is the only care you require.

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Sometimes, the company may own an assisted living facility and a skilled nursing facility within the same building, or in a nearby one. Medicare coverage depends on the type of care you are receiving and if you meet certain criteria.

To be eligible for Medicare coverage for skilled nursing care

  • You must only have had a qualifying hospitalization and not have used all of your hospital days.
  • This care must be determined by your doctor.
  • Your current condition could be the reason that you are currently in hospital, or it may have developed while you were there (for instance, an infection you contracted while you were hospitalized).
  • These skilled nursing services must be considered medically required.

All conditions being met, you will be covered 100% for the first 20 days of residential care. After that, you will be responsible for $185.50 daily in coinsurance from days 21 to 100. After 100 days, Medicare does not provide coverage for this type care.

What about Medicare Advantage?

Medicare Advantage (Medicare Part C) must cover at least as much as Original Medicare. Because Medicare Advantage is private insurance that has been contracted through the government to cover medical expenses, each policy’s specific benefits are different.

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Medicare Advantage does not typically cover assisted living, or any other long-term care. However, it will continue to pay eligible medical expenses such as prescriptions, screenings, equipment, and doctor’s appointments if you are moved to an assisted living facility. You may also be eligible for transportation to your appointments, vision and hearing coverage, and memberships to the gym.

You may also be eligible for Original Medicare if you require short-term skilled nursing care immediately after a hospitalization.

How to pay for assisted living

According to Genworth, a major provider long-term care insurance, the national median cost of residential care in an assisted living facility was $51,600 annually in 2020.

In general, if you have long-term care insurance, your policy will usually cover these costs if you meet certain requirements. You may need to draw on your savings or home equity in order to pay for this coverage if you don’t have it.

When is it best to sign up for assisted living?

It is an emotional and financially difficult decision to move into assisted living communities. Here are some clear signs that assisted living may be the right choice for you if you’re not sure.

  • It can be difficult to take care of yourself. It can feel overwhelming to cook, eat and clean up after meals. This could lead to poor nutrition and unhealthy weight loss. Perhaps you have been skipping showers because of fear of falling, washing clothes less often than you should, having trouble bending to put socks on, or if the laundry basket is too heavy.
  • It can be difficult to take care of your home. It might feel too difficult to vacuum, scrub, and declutter your home.
  • Even at home, it can be difficult to move around. It can be difficult to get in and out of the bathroom, up and downstairs the stairs or out of bed in morning.
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Assistive living communities may also have minimum requirements. Some are restricted to residents over 62.

Be sure to verify that the assisted living community is licensed and reputable before you make your decision. Online tools are available from many state websites that enable you to search for assisted living communities in your region, verify licenses, and view inspection or investigation reports.