Are Health Care Services in Assisted Living Covered by Medicare?

Health care services in assisted living covered by Medicare are limited. The federal health insurance program pays for some medically necessary supplies and home health services, which seniors may receive in assisted living communities or from home health care agencies. However, Medicare doesn’t cover any costs for personal care or help with everyday activities, room and board, social programs or general wellness initiatives. Seniors must find alternative ways to pay for most assisted living costs.

Although seniors may get some Medicare-covered services in an assisted living facility, coverage is usually independent of the living setting and doesn’t reduce overall assisted living costs. Under Parts A or B, Medicare pays for prescribed durable medical equipment, such as mobility aids, commode chairs and blood sugar meters. It doesn’t cover disposable supplies for home use, such as bandages and catheters. Some assisted living facilities offer in-house diagnostic services, such as X-rays and blood tests; Medicare covers associated costs. Government funding also pays for physical, speech and occupational therapy, which are sometimes offered at assisted living communities, as well as medical social services.

Medicare also covers intermittent skilled nursing services and, for those receiving nursing services, home health aide services. Seniors can receive such services in an assisted living community. However, they often fall beyond the facility’s scope of care, and external agencies provide these services for a supplemental fee. The insurance program continues to cover other standard medical services, such as in- and outpatient hospital care, and a senior’s living environment doesn’t affect Part D prescription drug coverage.

Because seniors can’t use Medicare to cover the bulk of their assisted living fees, they must find other ways to pay for their long-term care. Individuals may qualify for traditional Medicaid or Medicaid waivers that cover personal care and enrichment activities, although such programs don’t pay toward room or meal costs. Additionally, depending on the terms, long-term care insurance may reduce out-of-pocket assisted living costs. Most plans don’t include comprehensive cover, and yearly caps usually apply. Furthermore, plans usually have a waiting time between their creation and when an individual can claim, making planning ahead essential. Other potential ways to pay for assisted living include VA Aid and Attendance benefits, reverse mortgages and personal income and savings.