Does Medicare Or Medicaid Pay For Assisted Living In 2021?

If you or a loved one are getting to an older age and no longer able to safely live alone, then an assisted living facility might be a good option. However, those long-term care facilities can be extremely expensive. 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 about how much it might cost and your insurance coverage options.

Does Medicare Pay For Assisted Living?

Many people end up in the situation wondering how to pay for assisted living. Most Americans age 65 and older find themselves relying on Medicare in some form. Since Medicare is funded from your FICA taxes, will it pay for your assisted living? Unfortunately, Medicare does not usually pay for assisted living facility expenses. Medicare does not consider this type of care to be medically necessary in most cases. 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 most often occur when the patient is recovering from some type of illness or injury. The duration of the stay is usually limited to 100 days.

The major differentiator when determining coverage is the level of skill and care required at the facility. An assisted living community allows the residents to live more independently while having some minimum level of assistance. However, at a nursing facility they are receiving skilled care services like occupational therapy or physical therapy.

Services that Medicare usually does cover include:

  • Short term care in skilled nursing facility
  • Short term care in rehab facility
  • In-home rehab performed by 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 these costs. Does Medicaid pay for assisted living? Medicaid might help pay for the cost of assisted living 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 will need to plan ahead and purchase the insurance while you are 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 that you already have, the costs will probably not be covered under your policy.

Which Parts Of Medicare Cover Assisted Living Care & Expenses?

You have probably heard about the different parts of Medicare, and maybe got 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 talk a little about what each part covers and which parts might cover assisted living care.

Medicare Part A

Part A, also called Original Medicare, is similar to traditional hospital health insurance, and Medicare Part A offers you the best chance of having your expenses covered. Although Part A does not cover assisted living, it does cover short-term stays in facilities that are medically necessary. Part A covers inpatient hospital care, short-term stays in a facility with skilled nursing care, hospice care, and nursing home care in some situations. Most people receiving Social Security are enrolled in Part A.

Medicare Part B

So, what is Medicare Part B? Medicare Part B covers more traditional healthcare like doctor’s visits and outpatient services. Part B is not going to cover your expenses associated with assisted living. Part B does cover things like preventive treatments such as vaccines and annual exams. In addition, it provides coverage for mental health services and outpatient procedures. If equipment is needed for your medical care such as oxygen tanks or wheelchairs, then Part B provides coverage for these items.

Medicare Part C

Part C really provides no additional coverage on its own. Part C is really just a combination of Parts A and B. You might also hear Part C referred to as a Medicare Advantage Plan. Private insurance companies offer these plans which allow you to manage all your Medicare eligibility and claims through one simple plan. Items covered under Part C have already been discussed above in Parts A and B.

Medicare Part D

Part D is not going to cover expenses for an assisted living facility. Part D provides prescription drug coverage. These plans may be administered through private companies who contract with Medicare much like Part C plans. Enrollment in Part D is not mandatory, so you can choose whether it makes financial sense for your situation or not. More information is available concerning Part D on the Medicare.gov website. You can also use the website to request a new Medicare card and perform many other services.

Medigap

Medigap is supplemental insurance that can help cover out of pocket expenses like coinsurance payments and deductibles. Medigap does not cover the cost of care in assisted living facilities.

How Much Does Assisted Living Care Cost?

According to a 2020 study conducted by Genworth Financial, assisted living costs an average of $4,300 per month. The cost of care varies based on your location, the services offered at the facility, and the type of room you choose. Some seniors find themselves looking 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 these high prices for this type of care. This often puts both a financial strain and emotional stress on their caregivers. When a person is no longer able to safely perform the activities of daily living, it can be difficult to find custodial care for that loved one since Medicare does not cover the extremely high costs of this care.

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 benefits of these facilities is the fact that they 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 greatly reduce the amount of loneliness that one might experience. Meals and safe transportation are two more benefits you will experience with this type of senior care. Having access to fresh and healthy meals as well as safe and reliable transportation is a huge plus to 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 required by its residents. 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. Residents of assisted living are much more independent, which nursing home residents are typically unable to care for themselves.

Conclusion

Assisted living can be extremely expensive, and unfortunately, Medicare does not pay for these costs. Some Medicaid services might pay for a portion 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 setting yourself up for success should the need for long-term care arise.

Frequently Asked Questions

What is assisted living?

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 here can usually come and go as they please, and the facility typically resembles an apartment and not a medical office.

How does one pay for assisted living?

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 a good way to help pay for these facilities. However, you must plan early and purchase this insurance before the need for care arises. Most people purchase a policy like this while in their 40’s or 50’s.

How can I pay for assisted living with no money?

Individuals with no income and limited resources might be able to pay for assisted living expenses through a Medicaid program. These programs are funded jointly through Federal and state government funds, and they are designed to help those with no resources. While Medicare does not pay for assisted living, Medicaid does pay some of the costs in some cases.

Do Medicare and Medicaid pay for assisted living?

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, and this includes paying some of the costs for assisted living as well. Medicare only covers short-term stays in nursing homes or skilled nursing facilities.

How do I choose a nursing home?

​This is an extremely important decision that should not be taken lightly. You should consult multiple resources before making this decision. First, tour the facilities to get an idea of where you feel most comfortable. Next, consult your doctor for his or her opinion of the facilities that you are considering. Finally, check with your insurance company or Medicare to determine the costs of each. Weigh all the factors appropriately before making the final decision on which facility to choose as this decision can have lasting impacts for years to come.

Elliot Marks

Elliot Marks

Author & Social Security Advisor

Elliot Marks has spent over 10 years providing clear and concise information to help Americans navigate the complex nuances of social security and many other government services in the United States. Elliot has a passion for helping those in need of these services to be able to find timely access to news and information that is relevant and helpful to their daily lives.