Are Assisted Living Facilities Typically Covered By Health Insurance?

Assisted living facilities aren’t typically covered by health insurance, but certain medical services that facilities offer might, depending on your coverage. These communities focus on nonmedical care and assistance with daily living activities, including dressing and bathing. Many also offer on-site skilled nursing services that some insurance plans cover. Other financing options, including long-term care insurance, provide stronger financial support for assisted living.

Health insurance covers medical services from hospitals, doctors or other health care providers. Assisted living communities employ or schedule visits with certified medical professionals to provide care and maintain resident health. Common services include:

• Physician care
• Medically necessary tests and procedures, including diagnostic imaging and lab work
• Prescription medications
• Rehabilitative therapies
• Mental health services
• Diabetes or wound management
• Home health care services

Exact coverage depends on your insurance policy and whether it outlines any exclusions or limitations. Non Medical services, including housing and personal care assistance, don’t qualify for health insurance coverage. However, they do qualify for alternative financing options.

Long-term care insurance specifically covers personal care services and support. Policies vary widely, making it important to review your plan before accessing care. Life insurance policies also offer financial benefits. Adults aged 65 and older in a life settlement can sell their policies and use the proceeds to pay for care. How much money you receive depends on your life expectancy, the policy’s face value and how much the buyer pays in premiums while you’re alive. Government assistance programs, including veterans’ benefits and Social Security income, present additional financing opportunities. The Aid and Attendance benefit provides monthly payments for eligible veterans to use toward personal care assistance but not room and board. You must submit proof of condition to receive benefits. Meanwhile, Social Security offers monthly payments for retired, disabled or low-income individuals or their surviving family members, with no restrictions on usage. If you have the means, consider using personal funds, including savings, retirement income or investments to pay for care. It’s also possible to use a combination of financing options upon meeting eligibility requirements.