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Does Medicare Pay for Assisted Living?
Does Medicare Pay for Assisted Living? A Comprehensive Guide to Coverage. Many seniors and their families believe Medicare will cover the costs of assisted living. However, this isn’t entirely true. While Medicare pays for some aspects of senior living — like medications, treatment for chronic conditions, and products like bandages and incontinence supplies — it doesn’t cover the costs of rent, personal care, or help with activities of daily living. Learn how you can use Medicare to augment your savings when paying for your loved one’s assisted living community.
Understanding Medicare and assisted living
Does Medicare Pay for Assisted Living? Medicare is federal health insurance for people over 65, younger people with disabilities receiving Social Security benefits, and anyone diagnosed with Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease. It covers medical care such as doctor visits, prescription drugs, and stays at a hospital.
Assisted living is a senior housing option designed for older adults who are still moderately active and independent, but who may need help with certain daily tasks. Assisted living provides help with personal care such as bathing, using the bathroom, or preparing meals, which are all considered nonmedical care.
Does Medicare pay for assisted living?
No, Medicare doesn’t pay for room and board or nonmedical care in assisted living or many other types of long-term care. However, Medicare normally covers the cost of medical services offered at a community by third-party providers.
For example, an assisted living community might partner with an independent home health care agency for physical therapy, or they may host appointments from a visiting doctor. In some cases, they’ll provide injections for residents with diabetes or change bandages. These medical services would usually be covered by Medicare.
Medicare Supplemental Insurance, also called Medigap, and Medicare Advantage plans also don’t pay for assisted living rent, but they may pay for the services mentioned above.
Does Medicare cover assisted living for people with dementia?
Like assisted living, memory care offers seniors a safe, secure, and residential environment in which to age. However, memory care is designed for older adults with dementia or cognitive decline.
Medicare does not pay for room and board or personal care services in memory care, but it can cover some of the medical costs residents might require. This could include cognitive assessments, care planning, hospital stays, or prescriptions.
Seniors with dementia may benefit from a Medicare Special Needs Plan (SNP). A Medicare SNP is a type of Medicare Advantage Plan that’s limited to people with specific diseases or conditions. An SNP tailors the benefits, providers, and covered drugs for people in the group they serve.
Someone with dementia could be eligible for a Medicare SNP if they have Medicare Part A and Medicare Part B and reside in the plan’s service area.
How much does Medicare pay for assisted living?
Based on the information above, you know that Medicare doesn’t cover the residential costs of assisted living or memory care. However, there are ways your family can use Medicare benefits to augment savings and personal funds when paying for senior living.
When Medicare can cover long-term care services: Nursing facilities, medical supplies, and hospice care
Your loved one’s Medicare benefits can cover long-term care services offered in assisted living communities under certain circumstances. It also may cover other types of long-term care, like brief stays in nursing homes or skilled nursing facilities (SNFs).
Medicare benefits in assisted living communities include the following:
- Medical supplies like wheelchairs, oxygen, and walkers
- Physical, occupational, or speech therapy
- Part-time or intermittent skilled nursing
- Medical social services to cope with issues from an illness
Talk with a Senior Living Advisor
If a doctor determines these supplies or therapies are necessary to treat an injury or illness, your loved one can benefit from them in an assisted living or memory care community, in another senior care facility, or at home.
Medicare will pay for a short-term stay at a nursing home or SNF if a senior meets these three criteria
- They were in the hospital for at least three days.
- They were admitted to a Medicare-certified nursing facility within 30 days of their hospital stay.
- They were in need of skilled care or rehabilitation services as a result of their medical conditions.
Medicare can pay for at least part of the costs up to 100 days. During the first 20 days, it covers the total cost. A daily copayment is required for the remainder of the time period. Medicare will only pay if the patient makes improvement in therapy or if skilled care is needed to prevent a decline in their physical condition.
Medicare will pay for hospice in an assisted living community if your loved one fits these criteria:
- They have decided to no longer seek treatment for a terminal illness.
- A doctor has determined they have a life expectancy of six or fewer months.
- They wish to use medication or therapy to control symptoms or pain from a chronic condition.
Some of the services that Medicare may cover in hospice include drugs to control symptoms or pain, medical and support services, some respite care, and grief counseling.
Other ways to pay for assisted living
The median monthly cost of assisted living in the U.S. was $4,500 in 2021, a price that leaves many seniors searching for ways to pay for care. While Medicare doesn’t cover assisted living, there are other ways to pay for senior care. Many seniors use savings to finance assisted living, but some other options to consider include the following:
A Place for Mom’s Senior Living Advisors also provide expert guidance about finding local assisted living that fits a senior’s unique needs and price range. Plus, they can help set up tours, compare options, and plan the logistics of a move — all at no cost to families.
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