As you get older, you may need some kind of long-term care. Assisted living is one option for people who can generally take care of themselves, but need some help managing things like housekeeping, meals or other chores. Residents at an assisted living facility usually don’t need the type of round-the-clock care provided in a nursing home.
Medicare won’t cover most assisted living costs. Medicare does not pay for “custodial care,” a term referring to help with daily life tasks, such as eating, bathing or dressing. Most of the care given at an assisted living facility is considered custodial care. But there are some assisted living costs that Medicare may cover.
Assisted living costs covered by Medicare
Medicare usually won’t cover custodial care, but under certain conditions, it may cover skilled nursing care. This is care usually provided or supervised by a certified nursing professional or doctor. It includes services like physical therapy or changing sterile dressings. In assisted living environments, this care may be covered by Medicare Part A.
However, you won’t usually get skilled nursing care at an assisted living facility. Assisted living normally provides custodial care and supervision, but not the type of medical treatment typically found in a nursing home. But there are a few things in an assisted living facility that Medicare may help cover, such as transportation to doctors’ appointments or some preventive health services.
Medicaid includes coverage for assisted living costs
Medicaid is a joint federal and state program that may provide some coverage for assisted living. Not everyone qualifies for Medicaid. The types of care covered by Medicaid and income qualifications for the program vary from state to state. Visit Medicaid’s state overviews list for more information on what Medicaid covers in your area.
Do Medicare Advantage plans include assisted living coverage?
Medicare Advantage, sometimes called Medicare Part C, may help cover some long-term care costs. Medicare Advantage plans are offered through private insurers and include everything covered by Part A and Part B. These plans also sometimes help pay for services not offered by Part A and Part B, like personal or custodial care. Not all Medicare plans are the same. Costs and coverage options may vary from plan to plan or between insurance providers.
Eligible Medicare long-term care coverage
Medicare Part A may cover skilled nursing care in some long-term settings. However, Part A only pays for these services for up to 100 days. Medicare Part A can help cover skilled nursing care in certain conditions for a limited time if all of these conditions are met:
- You have Part A and have days left to use in your Medicare benefit period
- You have a qualifying hospital stay
- Your doctor decided that you need daily skilled care
- The skilled nursing facility (SNF) where you get skilled services is certified by Medicare
- You need these skilled services for a medical condition that’s either:
- A hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay, even if it wasn't the reason you were admitted to the hospital
- A condition that started while receiving care in the SNF for a hospital-related medical condition (for example, you develop an infection that requires IV antibiotics while getting SNF care)
How much does assisted living cost?
The price of assisted living can vary based on several factors. According to the 2021 Genworth Cost of Care Survey, the average cost of assisted living in the U.S. is $4,500 a month.1 It’s important to remember that what you pay for assisted living may differ based on where you live, the type of facility you choose, or the level of care and service provided.
Alternate ways to pay for assisted living costs
Medicare Part A only covers skilled nursing care and only for up to 100 days. If you need help with other costs of assisted living, you may have other options:
- Medicaid: Along with Medicare, Medicaid may help you cover some of the costs of long-term care. Your eligibility for Medicaid depends on your income. This eligibility requirement may vary from state to state, along with the services covered by Medicaid. Visit the Medicaid State Overview page to see details of Medicaid coverage where you live.
- Social Security Administration Programs: Depending on your medical condition or income, you might qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI). Social Security also offers “compassionate allowances” for people with certain serious conditions to help them get disability benefits more quickly.
- Long-term care insurance: These are plans offered through private insurance providers. They may cover several types of long-term care. Details of coverage and costs may vary from plan to plan.
When assisted living facilities make sense
Making a move to an assisted living facility is a big decision. Even if you can live on your own, the National Institute on Aging recommends talking to friends and family to make a plan for long-term care in the future. Planning ahead could help you navigate assisted living costs and make informed decisions based on your needs. People with Alzheimer’s disease or other cognitive impairments should make plans for long-term care as soon as they can.