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What Does Medicare Pay For in Assisted Living Facilities?
Date Updated: July 26, 2024
Written by:
Rachel Lustbader is a writer and editor with a background in healthcare and technology. Her work has been published on websites including HealthCare.com, BiteSizeBio.com, BetterHelp.com, Caring.com, and PayingforSeniorCare.com. She studied health science and public health at Boston University.
Both of Rachel’s grandmothers had very positive experiences in senior living communities, and Rachel saw firsthand the impact that kind, committed caregivers and community managers can have on seniors’ and their family members’ lives. With her work at Caring, Rachel hopes to help other families find communities, caregivers, and at-home products that benefit elderly loved ones and make life less stressful for family caregivers
Medicare pays for skilled nursing, home health care and hospice care in assisted living facilities but does not pay for the room and board costs or custodial care. Some assisted living communities offer skilled nursing in addition to senior apartments on-site.
Medicare can be used to pay for the qualifying medical services provided to residents requiring specialized care following an injury or illness. Coverage is based on both federal and state laws. For non-qualifying costs, there are other payment options available for assisted living.
What defines a qualifying medical expense?
When an assisted living facility also offers skilled nursing, Medicare provides full coverage for short-term stays in a facility for up to 20 days following a hospitalization. Reduced coverage is offered for up to 80 days beyond that as long as medical services are addressing the outpatient treatment plan prescribed by a doctor after a hospital stay. This type of medical service is given to seniors placed in an assisted living facility until recovery is complete. Residential options for confined individuals include a private or shared apartment as well as detached housing where medical care is received.
How to use Medicare to pay for medical costs in assistedliving
Seniors automatically receive Medicare at the same time Social Security benefits begin. Should hospitalization occur while residing in an assisted living facility, Medicare covers the hospital stay and the specific care prescribed to ensure a patient’s full recovery. This includes an injury requiring surgery and an illness treated with antibiotics or medical-grade care. Treatment plans include physical, speech and occupational therapy in addition to wound care and preventative medical services. Medicare will also cover wellness or fitness programs and transportation to medical appointments.
Other options to pay for assistedliving facilities
For any nonmedical costs in assisted living facilities, seniors and their families need to look outside of standard Medicare coverage. Potential options are Medicare Advantage plans, Medicaid, Veteran benefits, long-term care insurance and cashing in on life insurance. Families can also pool their resources, while investments such as annuities and homes without a mortgage can be used. Medicare remains useful for almost everything classified as medical services, but custodial care needs to be funded through other sources.