While Medicare doesn't cover assisted living, you'll still pay for all services approved under Parts A and B, such as hospitalizations. Although Medicare doesn't cover assisted living, you'll continue to pay for all services approved under Parts A and B, such as hospitalizations, doctor visits, procedures and tests. No, Medicare doesn't pay for assisted living. For residents of assisted living facilities, Medicare support is generally limited to health care-related expenses, such as doctor visits and on-site therapy.
It cannot be used to pay for daily living costs, such as room and board, or to help with activities of daily living (ADL), such as bathing and dressing. For these services, you or your loved one will need to use private payment methods, such as personal savings or retirement funds. The KFF asked states what services they provide in assisted living centers through Medicaid home care programs using the Centers for Medicare and Medicaid Services (CMS) list of services, which are classified under a comprehensive taxonomy. Some older long-term care policies may offer lower benefits for assisted living than for nursing homes.
While Medicaid doesn't cover room and board in assisted living facilities, Medicaid may cover home care for residents of assisted living facilities and some states may have policies to defray the costs of room and board (see below). Under the provisions of this rule, assisted living facilities that provide home care under Medicaid must provide “protections comparable to those that tenants have under landlord and tenant law in a given state, county, and city.” The cost of assisted living depends on where you live, the type of facility and the level of care you need. A Place for Mom's senior housing counselors can help you find local assisted living options that fit your loved one's unique needs and price range. Because assisted living isn't considered a medical need, it's not included in Original Medicare coverage. However, some states have exemption programs that provide certain Medicaid coverage for assisted living to eligible applicants. States usually offer home care in assisted living facilities through exemptions such as 1915 (c) (32 states), which are generally tailored to specific populations.
These states have limits on the monthly fees that assisted living facilities can charge Medicaid members, which are calculated based on of affiliate income. It's unknown how many assisted living facilities accept Medicaid, but the National Center for Assisted Living estimates that Medicaid pays for the daily services of about 200,000 people (about one in five residents). This is a price that causes many older people and their families to look for additional ways to pay for care, such as veterans benefits and Medicaid. Original Medicare doesn't cover assisted living, but it does cover short-term care in a skilled nursing facility.
Some services provided in an assisted living home may also be included in your Part A coverage. Keep reading to learn more about Medicare assisted living coverage, similar services covered by Medicare, and alternative ways to get help paying for assisted living.
