Does Medicare Cover Assisted Living?

While Medicare typically does not cover long-term custodial care (assistance with routine daily activities, like bathing, eating and dressing) in an assisted living facility, Medicare typically does cover medically necessary care in a skilled nursing facility.

If you are admitted for inpatient care at a skilled nursing facility, you will typically face some out-of-pocket Medicare costs. A Medicare Supplement (Medigap) plan can help pay for some of your skilled nursing facility costs, such as deductibles and coinsurance.

While Medicare doesn't cover assisted living, it does typically cover care at a skilled nursing facility.

What's the Difference Between Long-Term Care and Skilled Nursing Care?

Long-term care includes services with both medical and non-medical purposes. These services may be provided at individuals’ homes, as well as at assisted living facilities.

Skilled nursing facilities, on the other hand, are designed for those with chronic illnesses or disabilities.

In these facilities, Medicare covers the costs of:

• Semi-private rooms

• Meals

• Physical and occupational therapy

• Speech and language pathology services

• Medications

• Ambulance transportation

• Other services and costs

Although it doesn't usually cover assisted living costs, Medicare Part A covers up to 100 days of care in a skilled nursing facility if you meet certain conditions. Medicare also covers hospice care and eligible home health services (but not custodial care).

Assisted living facilities, though not covered by Medicare, can have a positive effect on a senior's quality of life.

Assisted living facilities may offer meals, personal care, 24/7 supervision and social activities to help residents maintain a high quality of life. They may also help with taking medication and transporting residents to appointments.

Seniors typically pay for nursing home care and assisted living center care out-of-pocket or with the help of long-term care insurance.

If you're eligible for Medicaid, it can help pay for long-term care,  but you must choose a facility that accepts Medicaid as payment.

Medicare Supplement (Medigap) Plans Can Help Pay for Skilled Nursing Facility Care 

Medicare beneficiaries can be responsible for numerous out-of-pocket costs, including deductibles, copayments, coinsurance and more.

Medicare Supplement Insurance (Medigap) can help cover some of these out-of-pocket expenses you may face when you're admitted to a skilled nursing facility.

Eight of the 10 standardized plans in most states provide at least partial coverage of your Medicare Part A skilled nursing care coinsurance.

Because Medicare does not cover long-term custodial care provided in an assisted living facility, however, a Medigap plan will not either.

A licensed agent can help you decide on a Medigap option that works for you. Call today to speak with a licensed agent and compare the Medigap plans that are available where you live.

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.