Does Medicare pay for assisted living?

How much does assisted living cost?

The median cost of an assisted living facility was $4,500 a month in 2021, according to Genworth's most recent cost of care study. That comes to $54,000 a year, compared with more than $9,000 a month or $108,000 a year for a private room in a nursing home. Long-term care costs vary significantly by age, location and type of care.

Though some families rely on their own money, such as accumulated personal savings, pension plans and retirement accounts, to help defray the cost of assisted living, long-term care insurance also can come into play here. You can compare costs among facilities and services with the AARP Long-Term Care Cost Calculator.

Will Medicare cover short-term stays at nursing facilities?

Though Medicare won’t cover assisted living or nursing home stays, it will cover some short-term stays in a Medicare-certified skilled nursing facility (SNF). That includes a doctor-prescribed rehabilitation center for specialized nursing care and rehab after a hospital stay.

Care in a skilled nursing facility is covered only if you had a qualifying hospital stay, which means that you were admitted as an inpatient in the hospital for at least three consecutive days. You must be admitted to the nursing facility within 30 days of leaving the hospital for an illness or condition related to the hospital stay. Your doctor must certify that you need daily skilled care from, or under the supervision of, skilled nursing or therapy staff.

For people who qualify, Medicare Part A covers eligible SNF stays with the following copayments in 2024:

• Zero dollars for days 1 to 20.

• $204 a day for days 21 to 100.

After 100 days, you become responsible for covering all skilled nursing facility costs. If you have a private Medicare supplement policy, also known as Medigap, it may cover the copayment for an SNF stay; however, policies will not cover assisted living costs that Medicare doesn’t cover.

How can I get help paying for assisted living?

Even though Medicare doesn’t cover the associated costs of assisted living facilities, you can get help paying for them with:

Long-term care insurance. If you have a long-term care insurance policy, you’ll usually have coverage for assisted living facilities. After a predetermined waiting period, the policy will generally pay if you need help with at least two activities of daily living — such as bathing, dressing and eating — or if you have cognitive impairment.

Some older long-term care policies may pay out smaller benefits for assisted living than for nursing homes. Most newer policies cover them at the same rate.

Medicaid in some states. Medicaid generally covers nursing homes for people with low income and assets. But some states have waiver programs that provide some Medicaid coverage for assisted living to eligible applicants.

The rules vary by state. Some have enrollment caps and long waiting lists to qualify for assisted living coverage. It’s important to note that once your state finds you eligible for a Medicaid waiver, if you move out of state — for example, to an assisted living facility near a family member in another state — your eligibility in the state where you became eligible is no longer valid.

You can’t be eligible in two states. Contact your state Medicaid agency or Area Agency on Aging for specifics.

Veterans benefits. Some military veterans and surviving spouses who receive a VA pension can qualify for Aid and Attendance benefits to help pay for care in a nursing home, assisted living facility or within their own home. To qualify, the veteran must meet service, asset and income requirements.

A doctor must certify that you need help with activities of daily living, such as bathing, dressing and eating. For more information, contact your regional VA office or an accredited veterans service organization.

Keep in mind

Medicare Advantage plans typically won’t help. Private Medicare Advantage plans, an alternative to original Medicare, must cover at least the same medical services as Medicare Part A and Part B. But they usually have different copayments and deductibles and may require you to use a provider network.

In-home help may be more robust. Even though Medicare Advantage plans don’t cover assisted living, some provide additional coverage that can help with caregiving needs such as adult day care, caregiving support, limited meals at home and transportation to medical appointments. The specific benefits and limitations vary a lot from plan to plan.

Find out more about the plans available in your area by using the Medicare Plan Finder. Then ask a plan that you’re interested in for more information about the additional coverage.

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