Does Medicare Cover Assisted Living?
This article was updated on: 07/25/2017
If you or a loved one needs help managing the activities of daily life, you may be considering assisted living facilities as an option. Here’s what you need to know about Medicare coverage for assisted living.
What is assisted living?
According to the National Institutes of Health and Eldercare.gov, an assisted living facility is a long-term care option combining housing and daily self-care support services. Typically, assisted living facilities don’t offer full-time skilled nursing care, but they might help monitor your health and manage your prescription medications. You may be wondering about Medicare coverage of assisted living situations.
Medicare generally does not cover assisted living. Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). The other two “parts” of Medicare, Part C (Medicare Advantage) and Part D (prescription drug coverage), also don’t cover assisted living costs.
Medicare Advantage gives you a different way to receive your Original Medicare benefits – you get them through a private insurance company that contracts with Medicare instead of directly from the government. They provide all your Medicare Part A and Part B benefits except hospice care, which Part A continues to cover. Medicare Advantage plans might include other benefits, such as prescription drug coverage or routine dental care.
People who choose assisted living facilities may need help preparing meals, eating, bathing, dressing, attending to personal hygiene, and/or managing their daily medications.
Does Medicare cover assisted living facilities?
The services offered by most assisted living facilities typically qualify as custodial care for the purposes, and therefore usually are not covered by Medicare. Only skilled health-care services, such as treatment for wounds provided by a licensed nurse, may be eligible for Medicare coverage in most cases.
Medicare Part A may cover short-term stays in skilled nursing facilities, such as when you’re recovering from an operation, if custodial care (such as help with daily tasks like bathing or dressing) isn’t the only care you need.
Are there any alternatives to an assisted living facility?
Original Medicare (Part A and Part B) may cover qualifying stays in a skilled nursing facility if you are discharged to one immediately following an eligible inpatient hospital stay. A skilled nursing facility differs from an assisted living facility in that it provides a higher level of health-care services, according to the National Institutes of Health (NIH) publication Medline Plus. Skilled nursing facility care might include nursing, physical, respiratory, and occupational therapy, speech-language pathology, medication management, and dietary and nutritional counseling. Part A benefits are limited to a certain number of days per benefit period and subject to requirements of medical necessity; your health-care provider will help you decide if a skilled nursing facility is an option for you or your loved one.
In some cases, home health-care services may be a viable alternative to placement in an assisted living facility. Again, Medicare coverage is generally unlikely. You may be eligible for Medicare coverage for certain health-care services in your home if you meet eligibility requirements and your doctor believes it is medically necessary to treat your condition – but generally Medicare covers these services for a limited time. It’s important to remember that Medicare coverage in the home generally applies only to skilled health-care services performed in the home and usually does not extend to custodial care services performed by a home health aide or home-making aide.
In some situations, you might be able to save money by staying at home and hiring a home-health aide or home care services, depending on your level of need, according to the Eldercare Locator (a service of the Department of Health and Human Services).
Can I get financial assistance for assisted living facilities?
If you purchased a long-term care insurance policy, you may also qualify for benefits to cover assisted living facilities; check your policy documents for more information.
Do Medicare Advantage plans help with assisted living facilities?
As mentioned above, Medicare Advantage plans typically don’t cover custodial care in an assisted living facility, but they often offer additional benefits. For example, Medicare Advantage plans usually offer prescription drug coverage, and might offer coverage for routine vision, dental, and hearing services. Some plans even include membership in Silver Sneakers fitness programs. Please keep in mind that you are still responsible for your Part B premium if you choose to enroll in a Medicare Advantage plan.
If you need help understanding Medicare coverage and your assisted living options, I’m available to answer your questions. Click one of the links below to schedule a phone call or request an email with information prepared just for you. You can check out plans in your area by clicking the “Compare Plans” button. For immediate assistance, please call me or another eHealth licensed insurance agent at your convenience at 1-844-847-2660 (TTY users can call 711) Monday through Friday, 8AM to 8PM ET.