Does Medicare Pay for Assisted Living?

Assisted living is the stage between living on your own and needing full-time nursing care. You or your loved one may need assisted living if you need extra help with daily activities such as bathing, dressing, and meals, but don’t yet require around-the-clock care. Medicare alone does not pay for assisted living.

What is Assisted Living?

Assisted living is a facility where extra help for daily tasks is provided. An assisted living facility may provide assistance with:

• Meals
• Bathing
• Dressing
• Medications
• Laundry
• Housekeeping
• Exercise programs
• Occupational and physical therapy
• Social and recreational programs
• On-site security

Most assisted living facilities are set up with private or semi-private rooms and/or apartments. The facility may offer a range of care options, dependent upon each individual’s specific needs.  

The National Center for Health Statistics reports that there are over 28,000 assisted living facilities in the United States that provide care to over a million people. According to the AARP, the average cost for a spot in an assisted living facility is $4,500 per month or $54,000 per year. Most people who move into an assisted living facility will stay for an average of 28 months with 60% moving on to a nursing home.

The Assisted Living Benefits Covered by Medicare

Although Medicare does not cover daily personal care, it may cover skilled nursing care for specific situations. This could include care provided or supervised by a certified nursing professional or doctor. 

Some care services that may be covered by Medicare are:

• Physical therapy
• Changing sterile dressings
• Transportation to doctors’ appointments
• Preventive health services 

To access skilled nursing care or medical treatment, you may need to transfer to a Long-Term Care facility

Does Medicare Advantage Cover Assisted Living?

Medicare Advantage, also called Medicare Part C, is offered through private insurance companies and may include coverage not provided by Part A and Part B. Medicare Advantage plans may help to pay for personal or daily care.

In some situations, Medicare Part A will cover skilled nursing care but only if ALL of these conditions are met.

You must:  

• Need care for less than 100 days 
• Have days left in your Medicare benefit period
• Have had a qualifying hospital stay
• Have your doctor recommend daily skilled care
• Be in a facility certified by Medicare
• Have a hospital-related medical condition or one that developed while receiving care for a hospital-related medical condition 

Deciding to Move to an Assisted Living Facility

Making a move to an assisted living facility is a life-changing decision. There may come a time when you or your loved one needs more support and care than your family, friends and local services can provide. 

To start, you want to talk with your loved ones about what type of care or support is needed. Some things to ask yourself:  Are you looking for a facility with a robust social schedule and frequent outings? Or would you prefer a quiet environment or one surrounded by nature? Would you rather eat in a dining room setting or have the option to prepare your own meals?  Do you need to be close to family or friends?

Make a list of the facilities that meet your criteria, then set up a time to visit the facility and interview the administrator, staff and/ or residents.  It is important the person who will be living at the facility be heavily involved in making the decision about which location is the best fit. 

How to Apply for Assisted Living

Most assisted living facilities will provide a contract that outlines in detail the costs, the care provided and the policies. It is imperative that you take your time with the contract to make sure you understand all of the terms.

You may also want to do a background check on the facility through the National Center for Assisted Living website. The AARP and the NCAL both offer checklists of questions to ask a facility before making your final choice.

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