Medicare Does Not Pay for Room and Board in Assisted Living Facilities

Medicare does not cover the cost of living in an assisted living facility — the rent, meals, utilities, or housekeeping that make up most of what you pay each month. Original Medicare (Parts A and B) and Medicare Advantage plans treat assisted living as custodial care, which is not a covered service. If you move into an assisted living facility, you pay the full cost yourself, usually between $4,500 and $6,500 per month depending on your location and the level of care you need.

The one exception is temporary skilled nursing care. If a doctor orders skilled nursing or physical therapy after a hospital stay, Medicare may cover up to 100 days in a facility that is certified to provide skilled care — but only the skilled services themselves, not room and board. Many assisted living facilities do not have the certification to bill Medicare for skilled care, so you should ask directly before assuming coverage applies.

Because Medicare does not cover assisted living, you need a separate plan to pay for it. That plan might be Medicaid (which does cover assisted living in some states), long-term care insurance, savings, family help, or a combination of these.

Key Takeaways

  • Medicare does not pay for assisted living room, board, meals, or housekeeping — you pay the full monthly cost out of pocket.
  • Medicare may cover skilled nursing or therapy services for up to 100 days after a hospital stay, but only if the facility is certified and a doctor orders the care.
  • Medicaid covers assisted living in some states but has strict income and asset limits that vary by state.
  • Long-term care insurance, personal savings, and family resources are the main ways people pay for assisted living when Medicare does not cover it.
  • You should ask a facility whether it is certified for skilled nursing before moving in, because certification affects what Medicare can pay.

When Medicare Covers Skilled Care Inside an Assisted Living Facility

Medicare covers skilled nursing care and rehabilitation services in an assisted living facility only if three conditions are met: you were hospitalized for at least three consecutive days, a doctor orders the skilled care, and the facility holds a Medicare certification for skilled nursing. The coverage lasts up to 100 days, with Medicare paying the full cost for days 1 through 20, and you paying a daily coinsurance amount (currently $200 per day) for days 21 through 100.

Skilled care means nursing services that require a licensed nurse — wound care, medication management, catheter care, or monitoring after surgery. Physical therapy, occupational therapy, and speech therapy also count as skilled services. If you need help with bathing, dressing, or meals but not skilled nursing, Medicare does not cover that, even in a certified facility.

Not all assisted living facilities are certified for skilled nursing. Some are licensed only for custodial care and activities of daily living. Before you choose a facility, ask whether it holds a Medicare provider agreement and whether it can bill Medicare for skilled nursing. If it cannot, Medicare will not pay for any services there, even if you need them after a hospital stay.

How Medicaid Covers Assisted Living in Some States

Medicaid is the program that actually covers assisted living in many cases — but only in states that have chosen to cover it, and only if you meet strict income and asset limits. As of now, about 40 states cover assisted living through Medicaid, but the rules differ widely. Some states cover it as part of their regular Medicaid program; others offer it only through a waiver program that may have a waiting list.

To be may be able to access for Medicaid-covered assisted living, your monthly income must be below a certain threshold (usually around $2,500 to $3,000, but this varies by state) and your countable assets must be below a limit (often $2,000 to $3,000). Your home, one car, and some personal items do not count toward the asset limit, but savings, stocks, and other property do. Medicaid also looks at whether you transferred assets to family members within the past five years — if you did, you may face a penalty period during which Medicaid will not pay.

The best way to find out whether your state covers assisted living through Medicaid and what the income and asset limits are is to contact your state Medicaid office or call 211 and ask for a Medicaid counselor. Do not assume your state covers it, and do not assume you are ineligible without checking — the rules are state-specific and change.

Long-Term Care Insurance and Personal Savings as Payment Options

If you bought a long-term care insurance policy before you needed assisted living, it may cover part or all of the monthly cost. Long-term care policies vary widely — some cover assisted living, some cover only nursing homes, and some cover both. The amount they pay per day ranges from $100 to $300 or more, depending on the policy you bought and when you bought it. If you have a policy, contact the insurance company to find out what it covers and what you need to do to make a claim.

Most people without long-term care insurance pay for assisted living from savings, retirement accounts, or help from family. If you have savings, you can use them directly. If you have a 401(k) or IRA, you can withdraw money, though you may owe taxes and early withdrawal penalties depending on your age and the type of account. Some people sell their home to pay for assisted living, though that is a major decision that affects Medicaid may be able to access and family inheritance.

If you are running out of money, you may eventually become may be able to access for Medicaid. Some people plan for this by spending down their savings on care until they reach the asset limit, then switching to Medicaid. A Medicaid planner or elder law attorney can help you understand whether this strategy makes sense for your situation, though their services cost money upfront.

What to Ask an Assisted Living Facility About Payment and Coverage

Before you move into an assisted living facility, ask these specific questions about what Medicare and Medicaid will and will not cover:

  • Is the facility certified for Medicare skilled nursing care? If yes, ask to see the Medicare provider agreement.
  • Does the facility accept Medicaid? If yes, ask which Medicaid programs it accepts (some states have multiple programs with different rules).
  • What is the monthly cost for room and board, and what does that include?
  • If I need skilled nursing after a hospital stay, what is the daily cost for days 21 through 100 of Medicare coverage?
  • If I run out of money, what happens? Can I stay if I switch to Medicaid, or will I have to move?

Get the answers in writing, because verbal promises do not hold up if there is a dispute later. If a facility tells you Medicare will cover your stay, ask them to explain that in writing — if they cannot, they are likely wrong.

Planning Ahead: How to Prepare for Assisted Living Costs

If you think you may need assisted living in the future, start planning now. Find out what assisted living costs in your area by calling a few facilities and asking their current monthly rates. Then figure out how you would pay for it: Do you have savings? Do you have long-term care insurance? Would you be may be able to access for Medicaid if you needed to? Could family help?

If you have significant assets and are worried about the cost, you may want to talk to an elder law attorney or a Medicaid planner about long-term care insurance or other strategies. If you have low income and few assets, contact your state Medicaid office or call 211 to learn what programs might help you pay for assisted living if you need it.

Do not wait until you are in crisis to think about this. Assisted living decisions often happen quickly — after a fall, a hospital stay, or a change in your health — and you will make better choices if you have already thought through the money side.

Frequently Asked Questions

If I move into assisted living after a hospital stay, will Medicare pay for any of it?

Medicare may pay for skilled nursing or therapy services for up to 100 days if the facility is certified and a doctor orders the care. It will not pay for room, board, meals, or help with daily activities like bathing. You pay the full cost of those services yourself.

Can I use my Medicare Advantage plan to pay for assisted living?

Medicare Advantage plans follow the same rules as Original Medicare — they do not cover assisted living room and board. Some Advantage plans offer supplemental benefits like transportation or meal delivery, but these are extras, not payment for the facility itself. Check your plan documents or call the plan to see what it covers.

What if I cannot afford assisted living and do not may have access to for Medicaid?

Contact your local Area Agency on Aging or call 211 to learn about other programs that might help, such as subsidized senior housing, home care information, or community services. Some nonprofits also help seniors pay for care. You may also have options to stay at home with paid help instead of moving to a facility.

If I move into assisted living, will I lose my Medicare coverage?

No. Moving to an assisted living facility does not affect your Medicare coverage. You keep your Medicare benefits and your coverage of doctor visits, hospital care, and prescription drugs. Medicare just does not pay for the facility itself.

Can I use my home equity to pay for assisted living?

Yes, you can sell your home or take out a reverse mortgage to pay for assisted living. However, selling your home may affect your Medicaid may be able to access if you later need Medicaid to pay for care. Talk to a Medicaid planner or elder law attorney before you sell, because the timing and structure of the sale matter.