Does Medicare Pay For Assisted Living?
The situation: My mom needs to move into assisted living. She has Medicare. Will Medicare pay for it?
Quick Answer
No. Medicare says it doesn't pay for long-term care, also called custodial care, which includes help with daily activities in an assisted living facility. Medicare can still pay for covered medical care your parent receives while living there, such as doctor visits. Families usually pay privately, or look at Medicaid or long-term care insurance.
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What Happened
Dana's mother, 82, needs help with bathing and medications and moves into an assisted living community that costs about $5,000 a month. Medicare doesn't pay the monthly fee, because it's custodial care. Medicare still pays its share of her mother's doctor visits and prescriptions, as before. Dana checks whether her mother's old long-term care policy pays a daily benefit, and asks the state Medicaid office about eligibility rules.
Likely Relevant Policies
- Original Medicare
- Medicare Advantage
- Long-term care insurance
- Medicaid
Potential Coverages
Medicare (for the assisted living cost) Low likelihood
Medicare says it doesn't pay for long-term care, including non-medical care in an assisted living facility.
Medicare (for medical care while living there) High likelihood
Covered doctor visits, tests and drugs are still covered under the person's Medicare plan.
Long-term care insurance Possible likelihood
Many policies pay a daily or monthly benefit for assisted living, depending on the policy's terms.
Medicaid Possible likelihood
Some state Medicaid programs help with care in some assisted living settings, subject to income, asset and medical rules.
Possible Exclusions
- Custodial care and room and board under Medicare
- Long-term care policy elimination periods before benefits start
Questions That Determine Coverage
- Is the care custodial (help with daily activities) or skilled medical care?
- Does your parent have a long-term care insurance policy?
- Might your parent qualify for your state's Medicaid program?
Recommended Immediate Actions
- Ask the facility for a written breakdown of fees.
- Look for any long-term care insurance policy and read its benefit terms.
- Contact your state Medicaid office about eligibility.
Documents to Collect
- Facility contract and fee schedule
- Any long-term care insurance policy
- Medicare and any supplemental plan cards
Common Claim Process
Medicare isn't billed for the assisted living fee. A long-term care insurance claim usually needs a doctor's assessment of care needs and starts paying after the policy's elimination period.
Potential Outcomes
- The family pays privately.
- A long-term care policy pays a daily or monthly benefit.
- Medicaid helps in some states, if your parent qualifies.
Risk Prevention Tips
- Plan for long-term care costs before they're needed.
- Know the difference between skilled care and custodial care.
Frequently Asked Questions
Does Medicare cover nursing homes?
Medicare says it doesn't pay for long-term care, including custodial care in a nursing home. It covers short-term skilled nursing facility care under certain conditions, which is different.
What's the difference between long-term care and skilled nursing care?
Long-term (custodial) care helps with daily activities like bathing and dressing. Skilled nursing care is medical care by licensed staff, which Medicare may cover for a limited time after a hospital stay.
Does Medicare Advantage pay for assisted living?
Generally not for the room and board. Some plans offer limited supplemental benefits, so check the plan.
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The factual claims on this page were checked against these sources. Rules and figures change, so check the source itself if you need to confirm the current version.
- Long-term careMedicare.gov (Centers for Medicare & Medicaid Services)
Educational information, not advice: This page describes how Medicare coverage generally works, not how your plan will decide a specific bill. Check your plan's details with the plan or at Medicare.gov. This is educational, not medical or legal advice.