If you or a loved one are getting older and can no longer safely live alone, then an assisted living facility might be a good option.
However, those long-term care facilities can be costly. Many people do not have enough savings or income to pay for that type of care. Individuals age 67 and older may be covered by Medicare, so will your Medicare coverage pay for assisted living care?
Those with limited income and assets may qualify for Medicaid, so what are the options with that coverage? If an assisted living facility might be in the future for you or a family member, then keep reading to learn how much it might cost and your insurance coverage options.
Does Medicare Pay For Assisted Living?
Many people wonder how to pay for assisted living. Most Americans age 65 and older rely on Medicare in some form.
Since your FICA taxes fund Medicare, will it pay for your assisted living? Unfortunately, Medicare does not usually pay for assisted living facility expenses. In most cases, Medicare does not consider this type of care medically necessary.
The program will, however, pay for short-term care in a skilled nursing facility like a nursing home or rehab center. In some cases, in-home care also qualifies for coverage.
These short-term stays often occur when the patient is recovering from an illness or injury. They are usually limited to 100 days.
The major differentiator when determining coverage is the level of skill and care required at the facility.
Short-Term vs Long-Term Assistance
An assisted living community allows the residents to live more independently while having some minimum level of assistance. However, at a nursing facility, they receive skilled care services like occupational or physical therapy.
Services that Medicare usually does cover include:
- Short-term care in a skilled nursing facility
- Short-term care in a rehab facility
- In-home rehab performed by a skilled nurse or physical therapist
Services that Medicare usually does not cover include:
- Retirement community expenses
- Assisted living facilities
- Non-medical in-home care
- Long-term stays in nursing facilities
While Medicare does not cover assisted living expenses, there are other ways to cover them. Medicaid might help pay for them if the patient has extremely limited income and resources.
Additionally, long-term care insurance is probably the best option. However, you cannot wait until it’s too late to purchase this insurance. You must plan and buy the insurance while still in good health. Like many health insurance plans, your long-term care insurance policy might not cover pre-existing conditions.
So, if you require care in assisted living for a condition you already have, the costs will probably not be covered under your policy.
KEY TAKEAWAYS
- Original Medicare does not cover assisted living costs; however, it may cover some short-term care for skilled nursing facilities, rehab centers, or in-home care.
- A recent study put the average cost of assisted living at around $5,500 monthly; for most people, this is more than they can afford.
- Those eligible for Medicaid may have some of their assisted living costs covered.
Which Parts Of Medicare Cover Assisted Living Care & Expenses?
You have probably heard about the different parts of Medicare and may have been confused. Part A, Part B, Part C, and Part D – what are all those things anyway? So, where do Medicare and assisted living intersect? Let’s discuss briefly what each part covers and which parts might cover assisted living care.
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How Much Does Assisted Living Care Cost?
According to a 2024 study by Genworth Financial, assisted living costs an average of $5,500 monthly. The cost of care varies based on your location, the services offered at the facility, and the type of room you choose. Some seniors look at bills over $70,000 per year for elder care. That certainly provides some sticker shock to most people!
The average American is unable to afford the extremely high prices for this type of care, which often puts both financial strain and emotional stress on caregivers.
When a person can no longer safely perform the activities of daily living, it can be challenging to find custodial care for that loved one since Medicare does not cover the extremely high costs of this care.
TIP
Assisted living facilities can be costly; if you don’t think you’ll have funds to cover the cost, you may want to consider buying long-term care insurance before you experience any health issues.
What Are Some Of The Benefits Of Living In An Assisted Living Facility?
Assisted living offers many benefits to its residents. One of the biggest is that these facilities offer 24/7 care. Though the residents might not need this type of care all the time, loved ones are usually more comfortable knowing that the care is available if needed. This can be especially true for residents who have Alzheimer’s or other diseases.
Another benefit to living in this type of facility is social interaction. Many seniors suffer from loneliness and isolation, and living with other people in this type of community can significantly reduce the amount of loneliness that one might experience.
Meals and safe transportation are two more benefits of this type of senior care. Having access to fresh and healthy meals as well as safe and reliable transportation is a huge plus for these care facilities.
What Is The Difference Between Assisted Living & Nursing Homes?
The main difference between assisted living and a nursing home is the level of care its residents require.
- Assisted living facilities usually resemble high-end apartments. Its residents do not typically require constant care and monitoring.
- On the other hand, a nursing home has more of a hospital feel. Its residents usually require constant care and help with medications or daily activities.
Assisted living residents are much more independent, while nursing home residents are typically unable to care for themselves.
The Bottom Line
Assisted living can be costly; unfortunately, Medicare does not pay for these costs.
Some Medicaid services might pay for some of these costs for low-income individuals, but you might still be on the hook for part of the bill.
Knowing what each of these plans will pay for and how you can help cover additional costs is crucial to preparing for success should the need for long-term care arise.
Frequently Asked Questions
Assisted living is a facility with 24/7 staff to help assist its residents. Most of the residents are able to live safely on their own, though they might need a little help with daily activities like cooking meals or managing their medications.
Residents can usually come and go as they please, and the facility typically resembles an apartment rather than a medical office.
Unfortunately, Medicare does not cover these costs. People typically pay for assisted living through savings or with money from retirement accounts.
Purchasing long-term care insurance can be an excellent way to help pay for these facilities. However, you must plan early and buy this insurance before the need for care arises. Most people purchase a policy like this in their 40s or 50s.
Medicaid might allow individuals with no income and limited resources to pay for assisted living expenses.
These programs are funded jointly by the Federal and state governments and designed to help those with limited resources.
While Medicare does not pay for assisted living, Medicaid does sometimes pay some of the costs.
There are several differences between Medicare and Medicaid, including eligibility requirements and coverage benefits.
Medicare does not pay for assisted living, although Medicaid may cover some of the costs. Medicaid is designed to help individuals and families with limited resources, including covering some of assisted living costs.
Medicare only covers short-term stays in nursing homes or skilled nursing facilities.
This is a crucial decision that should not be taken lightly. You should consult multiple resources before making this decision.
- First, tour the facilities to understand where you feel most comfortable.
- Next, please consult your doctor for his or her opinion of the facilities you are considering.
- Finally, check with your insurance company or Medicare to determine the costs of each.
Weigh all the factors appropriately before deciding which facility to choose, as this decision can have lasting impacts for years.
You can find a Social Security Administration office near you by using our SSA office locator and searching for your closest location.
