Does Medicare Cover Assisted Living? 

Getting older comes with a number of benefits, but for some seniors, it can also mean that you may need to ask for a little extra help from time to time. Older Americans are perfectly capable of living fulfilling lives, but medical concerns and the effects of age on the body can make it difficult to handle everyday tasks or seek medical care when needed. Assisted living facilities provide solutions to these challenges. Many retirees find that moving into an assisted living community is a way to maintain independence while also having help close by if needed.

What is assisted living?

An assisted living arrangement is one that provides nearby support in the event of a medical emergency. In some cases, entire communities will be created to provide assisted living services for residents. In others, a designated residential facility will be used for assisted living.

In addition to medical support, residents of assisted living communities or facilities usually have access to help around the home. Help with daily tasks like light housework or meal preparation may be provided for seniors in assisted living facilities or communities. Some assisted living care providers will also help with hygiene and rides to and from doctor appointments.

Is assisted living the same as nursing care?

Although both skilled nursing facilities, sometimes referred to as nursing homes, and assisted living facilities are similar, assisted living care is not skilled nursing care. Skilled nursing homes are facilities that are designed specifically to provide temporary medical care in a residential setting for individuals who cannot care for themselves. Assisted living facilities or communities are designed for seniors who are able to live independently but may require some additional assistance from time to time.

Does Medicare cover assisted living?

Medicare benefits are available for Americans who are 65 or older, and some individuals under 65 with qualifying disabilities. Medicare recipients are more likely to need assisted living care services. Will Medicare benefits apply toward the cost of assisted living care?

Unfortunately, Original Medicare benefits do not apply toward assisted living care. The program does cover skilled nursing care in some cases, as well as care in a skilled nursing facility. Inpatient services are provided through Medicare Part A. Medicare recipients can take advantage of benefits for skilled nursing care for a total of 20 days each benefit period.

After 20 days, an additional 80 days of inpatient care in a skilled nursing facility can be covered at a per-day rate. Once these days have been exhausted, lifetime reserve days can be used for continued inpatient care at a discounted per-day rate.

Medicare and long-term care coverage

Medicare benefits do not apply toward any type of long-term care. This includes nursing home care, assisted living care, in-home care or visiting care services. This is important to note because many seniors are under the assumption that Medicare Part A, the inpatient benefit, will pay for long-term care in the event of an illness or injury. Unfortunately, if you require any type of inpatient care beyond the limits of Medicare Part A, you will be required to pay the full cost of care out of your own pocket.

Do Medicare Advantage plans cover long-term care?

Medicare Advantage (MA) plans provide the same coverage options as Original Medicare insurance. You may, however, be able to receive extra benefits under a Medicare Advantage plan that are not available through Original Medicare coverage plans.

Your MA plan may offer some type of discount on additional inpatient care options, but this will be up to your provider. To learn more, you will want to contact your plan manager or speak with an independent Medicare Advantage plan broker to discuss your needs and see what solutions exist in your area.