Does Medicare Cover Assisted Living?

Medicare Benefits Solutions

Jun 15, 2021

Does Medicare cover assisted living? Getting older comes with a number of changes, and sometimes these changes include the need for a little bit of extra help in everyday life. While you may be healthy and active, additional help for things like light housework, transportation around town, and healthcare monitoring can make a big difference in your quality of life.

Many seniors find that assisted living services and assisted living facilities are vital to living their best during their senior years. Assisted living services vary, but most are designed to help people who can no longer live completely independently or who chose not to do so. 

Original Medicare is limited in scope regarding its coverage of assisted living, Medicare Advantage plans may be an option to consider. Medicare Advantage plans provide additional benefits on top of the Part A and Part B coverage. You may be able to receive extra benefits related to assisted living based on your plan and provider. Let’s discuss the difference between assisted living services and facilities, and find out how Medicare can help.

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Differences Between an Assisted Living Facility and In-Home Care

There are two main types of assisted living options: in-home care and residential care in an assisted living facility. In-home care means that you continue to live in your own home, and a services provider or nurse visits on a regular schedule to provide help with things around the home and with medical care.

An assisted living facility provides the same types of services, but instead of being provided in your home, you live at the facility. Most facilities will offer options to have your own room or a shared room, and your individual needs are met based on a specific care plan that is created for you.

Does Medicare Cover Assisted Living?

Original Medicare benefits are available for care in a skilled nursing facility under Medicare Part A. This is the inpatient benefit, but services are only covered on a temporary basis. In most cases, you are eligible to utilize benefits for up to 90 days at varying costs to you, but after you have reached the benefit period limit, you will need to use lifetime reserve days to receive any benefits from Medicare. Once these days are exhausted, your costs are 100% out-of-pocket.

If you require long-term assisted living care, Medicare does not provide a benefit for this. This includes in-home assisted living care and residential care in an assisted living community. Medicare benefits also do not cover expenses associated with living in a retirement community nor does they cover the cost of non-medical care services that include housework, transportation and similar services.

Medicare Coverage of Home Health Services

Even though Original Medicare doesn’t cover assisted living outright, the program does provide coverage for some home health services. These services include in-home physical therapy, intermittent home health aide services and injection administration of some medications at home. These services may be covered by a combination of Medicare Part A and Part B depending on the source of the services being provided.

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