Does Medicare Cover Assisted Living?

Let's get straight to the facts: Medicare does not pay for the cost of room and board at an assisted living facility. If you or a loved one are moving into assisted living, Traditional Medicare (Part A and Part B) will not cover the monthly rent, meals, or personal care services like help with bathing or dressing.

However, Medicare will still cover your approved medical care while you live in the facility. If you need to see a doctor, require physical therapy, or need prescription drugs, your Medicare coverage travels with you. The facility is simply your new home address.

We hear from folks every day who are shocked to learn that Medicare won't pick up the tab for long-term care. You've paid into the system your whole working life, and it's frustrating to find out that the paper promises don't cover the one thing that bankrupts so many families. But knowing the rules is the first step to protecting what you've earned. You can't rely on the government to handle your long-term care, which means you have to handle your own business.

When you live in an assisted living facility, here is how your Medicare coverage works:

Medicare Part A (Hospital Insurance)

Part A covers inpatient hospital stays, skilled nursing facility care (for a limited time after a qualifying hospital stay), hospice care, and some home health care. It does not cover custodial care, which is the type of non-medical care provided in assisted living facilities.

Medicare Part B (Medical Insurance)

Part B covers outpatient care, doctor visits, preventive services, and durable medical equipment. If a doctor visits you at the assisted living facility, or if you need a walker or wheelchair, Part B will cover these services just as it would if you were living in your own house.

Medicare Part D (Prescription Drugs)

Your Part D plan will continue to cover your prescription medications. The staff at the assisted living facility can help manage and administer your medications, but Medicare pays for the drugs themselves, not the administration of them by the facility staff.

When looking at the costs, the national median cost for an assisted living facility is over $4,500 per month [as of 2024, varies by location and age]. Since Medicare doesn't cover this, how do people pay for it?

• Private Pay: Most people pay out of pocket using savings, pensions, or the proceeds from selling a home.
• Long-Term Care Insurance: If you purchased a policy before you needed care, it can help cover the daily costs of assisted living.
• Medicaid: For those who have exhausted their assets, Medicaid may cover some assisted living costs, but this varies heavily by state and facility.
• Veterans Benefits: Veterans and their spouses may qualify for the Aid and Attendance benefit, which provides financial assistance for long-term care.

Remember the core rule of Medicare: it covers medical care, not custodial care. The choice between Traditional Medicare and Medicare Advantage doesn't change this fundamental fact. Both paths follow the same rules regarding assisted living. The real comparison is how you choose to receive your medical benefits while living there.

If you choose Traditional Medicare, you can see any doctor who accepts Medicare, which is crucial if you need specialized care. A Medicare Supplement (Medigap) plan fills the gaps by law, covering the deductibles and coinsurance that Medicare leaves behind. If you choose Medicare Advantage, you must use the plan's network of doctors, which may or may not include the medical providers who visit your specific assisted living facility.

You need straight answers, no surprises. Planning for long-term care is complex, and you shouldn't have to figure it out alone. We're on your side of the table, ready to walk you through every option so you can make the best decision for your family and your finances.