Medicare is a federal government program helping people over the age of 65 afford their health care costs. While Medicare provides valuable coverage, it does not cover everything. Unfortunately, this includes assisted living.

Assisted living communities give seniors round-the-clock care while providing opportunities for social engagements and new opportunities. Although an assisted living community gives seniors the care they need while helping to improve their overall quality of life, it can be rather expensive. As a result, those considering this form of care for their aging loved ones often ask, “Does Medicare pay for assisted living?”

Medicare does not offer coverage for assisted living; however, seniors and their loved ones still have various payment options available. Below, Horsham’s assisted living community staff at We Care Senior Solutions discusses what Medicare pays for and how potential residents and their families can pay for assisted living.

So What Does Medicare Cover?

If Medicare doesn’t cover assisted living, what does it cover?

Medicare is a health insurance program available to certain qualifying U.S. residents, including:

Those 65 and older
Those diagnosed with ALS (amyotrophic lateral sclerosis)
Those with ESRD (End Stage Renal Disease)

Original Medicare comes in two parts, both of which offer different levels of coverage.

Medicare Part A

Medicare Part A refers to the hospital insurance part of Medicare. It pays for inpatient hospital stays, hospice care, and skilled nursing care.

Medicare Part B

Medicare Part B is medical insurance that helps pay for doctor’s visits, lab work, durable medical equipment, and more.

Despite the numerous benefits, neither Medicare Part A nor B pays for long-term care.

Does Medicare Cover Short-Term Assisted Living Care?

Does Medicare pay for assisted living if it’s short-term?

While Original Medicare does not cover long-term assisted living, it does offer some coverage for short-term stays at a skilled nursing facility (SNF). However, these communities must be Medicare-approved.

In addition, Medicare beneficiaries will only receive coverage for short-term SNF stays if it follows a qualifying hospital stay. For example, a patient must have stayed in the hospital for a minimum of three consecutive days and be admitted to the SNF within 30 days of their hospital discharge.

Although Medicare offers coverage for SNF stays, beneficiaries are still responsible for copayments. For example, patients staying between one and 20 days have a $0 copayment, but they are responsible for paying $200 a day for days 21 through 100.

What Plans Can You Get with Medicare?

Original Medicare does not offer coverage for assisted living, but beneficiaries can still find greater coverage through different Medicare plans. Typically, beneficiaries can opt for two types of Medicare plans: supplements and advantage plans.

Medicare Supplement Plans

Medicare Supplement (Medigap) plans provide coverage for what Medicare doesn’t. In accordance with the Centers for Medicare & Medicaid Services (CMS), all Medicare Supplement plans must offer standardized benefits throughout the country.

While Medicare Supplement plans cover many of Original Medicare’s coverage gaps, they do not cover the costs of assisted living.

Medicare Advantage Plans

Medicare Advantage plans, or Medicare Part C, provide additional coverage to Original Medicare beneficiaries. Like supplement plans, independent insurance companies offer these plans, which means benefits vary from carrier to carrier. However, unlike Medicare Supplement plans, Advantage plans do not have standardized benefits nationwide.

Unfortunately, Medicare Part C typically doesn’t offer coverage for assisted living, but enrollees may receive coverage for skilled nursing facilities depending on the plan and carrier.

What About Medicaid?

Unlike Medicare, Medicaid is a state-based program offering enrollees coverage for various healthcare costs. According to the CMS, every state can maintain its own set of guidelines for Medicaid, which means coverage varies from state to state.

The good news is that Medicaid does provide some coverage for assisted living, giving qualified beneficiaries significantly more coverage than Original Medicare. Since Medicaid guidelines vary in each state, coverage for assisted living and nursing homes also varies depending on where you live.

To qualify for Medicaid, beneficiaries must meet the following enrollment requirements:

Live in the same state they want to apply for Medicaid in
Have an income below a certain level, as designated by the state

In addition, beneficiaries must meet different requirements to be eligible for Medicaid-paid assisted living. For example, Medicaid enrollees must live in a Medicaid-licensed community and demonstrate the need for assisted living services.

VA Benefits and Assisted Living Coverage

Veterans who meet at least one of the VA pension requirements may also receive coverage for assisted living. These requirements include:

The veteran is confined to a bed.
The veteran has a major impairment in vision.
The veteran is a current resident of a long-term care community.
The veteran needs help with activities of daily living, or ADLs.

If a veteran meets at least one of these criteria, they may be eligible for a monthly stipend from the U.S. Department of Veterans Affairs (VA) to cover the costs of assisted living or long-term care.

What About Long-Term Care Insurance?

Another option seniors have for assisted living coverage is long-term care insurance or LTCI. Several insurance companies offer these to provide coverage for long-term care services; however, they offer different premiums and policy coverages.

Enrollees can choose the type of coverage they want, which affects things like daily dollar amounts, length of stay, location, and activities of daily living.

An essential factor to consider with LTCI is the underwriting process. Due to this process, older enrollees may have a more difficult time finding coverage. Fortunately, beneficiaries can purchase these plans in their 40s, providing lower premiums and peace of mind.

Get More Help By Contacting Compassionate Professionals

Does Medicare pay for assisted living? Unfortunately, the answer is no. However, seniors and their families still have other coverage options to help pay for stays at assisted living communities, such as Medicaid, VA benefits, and long-term care insurance. In some cases, a person’s life insurance policy offers coverage for assisted living.

If you have more questions about assisted living costs or the expense of moving your loved one into a senior living community, call our caring professionals at We Care Senior Solutions in Pennsylvania at 610-970-4200.

Does Medicare Pay for Assisted Living?