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Alex Enabnit

No, Medicare does not cover assisted living. However, it can cover health costs while in assisted living.

In general, Medicare doesn’t cover custodial care. Custodial care is a type of senior care given to those who need help with activities of daily living (ADL), such as personal grooming, walking, bathing, dressing, or using the bathroom. Typically, those in assisted living require custodial care—they need help with one or more ADLs but remain otherwise independent.

If you are eligible for Medicaid, you may get assistance for long-term care like assisted living, but each state has its own rules. If you’re receiving Medicaid, contact your state’s Medicaid program to see if they can help cover assisted living expenses.

Does Medicare cover nursing homes?

Medicare doesn’t usually cover the costs for nursing homes either. Nursing home residents generally require help with even more ADLs than those in assisted living and may have a few medical needs too. But since nursing homes are basically custodial and for long-term senior care, Medicare doesn’t normally cover the cost.

If a person’s needs are beyond custodial care and require more complex medical treatment from skilled medical professionals, a Skilled Nursing Facility may be a better option than a nursing home.

Does Medicare cover a Skilled Nursing Facility?

Yes, Medicare Part A can cover Skilled Nursing Facilities (SNFs).

SNFs are different from assisted living or nursing homes because they are generally short-term, rehabilitative in nature, and must be approved by a doctor. SNFs can be thought of as a place where people rehabilitate from illness or surgery until they get back on their feet.

Some examples of people who need SNFs are those who need rehabilitation after surgery, people who require medical care around the clock, or people who were in a hospital but still need time to recover before they can live on their own.

In a Medicare-certified SNF, your costs under Original Medicare, in most cases, look like this:

  • $0/day for days 1–20
  • $170.50/day for days 21–100
  • Full amount/day for days 101+
Your Costs/DayDays in the SNF (in each benefit period*)
$01-20
$170.5021-100
Full amount101+

*A benefit period begins when you become an inpatient of an SNF or hospital, and it resets when you haven’t been an inpatient in either for 60 consecutive days.1

These costs are different for the people who buy certain insurance policies called Medigap (Medicare Supplement insurance). Medigap Plan C, D, F, G, M, and N cover your coinsurance for days 21–100 at an SNF, effectively covering a 100-day SNF stay 100% . Medigap Plan K and L also cover SNF coinsurance, but at 50% and 75%, respectively.

Unfortunately, no Medigap plans cover assisted living facilities or nursing homes.

To learn more about Medicare Supplement insurance (Medigap) or to find a Medigap plan appropriate for you, call an agent.

Does Medicare cover hospice care?

If your doctor verifies that you’re terminally ill with six or less months to live, Medicare covers 100% of hospice care. To receive this type of end-of-life care, you’d need to agree that you no longer want to treat the illness and prefer to live as comfortably as possible in your remaining time.

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Sources

1. Medicare.gov, “SNF Care Coverage

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