Medicare does not pay for assisted living facilities
Original Medicare — Parts A and B — does not cover the cost of living in an assisted living facility, even if you need help with daily tasks like bathing, dressing, or taking medication. Medicare covers hospital care, doctor visits, and skilled nursing care in a nursing home after a hospital stay, but assisted living is a different category. The difference matters because it changes where your money comes from and what options you actually have.
Assisted living facilities provide housing, meals, and personal care services. Medicare treats this as housing and personal support, not medical care. If you move to an assisted living facility, you pay for it out of pocket, through long-term care insurance if you have it, or through Medicaid if you meet your state's income and asset limits.
Key Takeaways
- Medicare Part A and Part B do not cover assisted living facility costs, including room, board, meals, or personal care information.
- Medicaid covers assisted living in many states, but only if your income and assets fall below your state's limits, and you must live in a Medicaid-certified facility.
- Medicare does cover skilled nursing care in a nursing home for up to 100 days after a hospital stay of at least three days, which is different from assisted living.
- Long-term care insurance, Veterans benefits, and out-of-pocket payment are the other main ways people pay for assisted living when Medicare does not cover it.
When Medicare covers nursing home care instead
Medicare does cover skilled nursing facility care, but only under specific conditions. You must have been hospitalized for at least three consecutive days, your doctor must order the skilled care, and you must enter the nursing home within 30 days of leaving the hospital. Medicare then covers up to 100 days, though you pay a daily copay after day 20.
Skilled nursing care means you need medical services — wound care, physical therapy, medication management — not just help getting dressed or remembering to take pills. If you improve and no longer need skilled care, Medicare stops paying even if you stay in the facility. This is why many people move from a nursing home to assisted living: the nursing home was covered by Medicare, but assisted living is not.
An assisted living facility may have a nursing home section on the same campus. If you may have access to for Medicare-covered skilled nursing care, that part is covered. The assisted living section is not.
How Medicaid covers assisted living in your state
Medicaid is a joint federal and state program, so coverage rules vary by state. Many states cover assisted living through Medicaid, but the income and asset limits are strict. In most states, your monthly income must be below $2,000 to $2,500 (the exact amount depends on your state), and your countable assets must be below $2,000. Your home and one vehicle usually do not count toward the asset limit, but savings, investments, and other property do.
You must also live in a facility that is certified by your state to accept Medicaid. Not all assisted living facilities are certified. Before you move, call the facility and ask whether they accept Medicaid and whether they have an open bed for a Medicaid resident. Some facilities accept Medicaid but have a waiting list or limit the number of Medicaid residents they take.
To find out your state's exact income and asset limits and which facilities are certified, contact your state Medicaid office or call 211 (a free referral line). They can tell you whether you may be may be able to access and which facilities near you accept Medicaid.
Other ways to pay for assisted living
Long-term care insurance is a private insurance policy you buy before you need care. It covers assisted living, nursing home care, and in-home care. The cost depends on your age when you buy it and the coverage level you choose. If you already have a policy, check what it covers — some policies cover assisted living, others do not.
Veterans benefits may cover assisted living if you are a veteran or the surviving spouse of a veteran. The VA Aid and Attendance benefit provides a monthly payment that can help pay for assisted living. You do not have to have a service-related disability to may have access to, but your income and assets must be below certain limits. Contact the VA or a Veterans Service Officer to learn whether you may be may be able to access.
Out-of-pocket payment is how most people pay for assisted living. The cost varies widely by state and facility — from roughly $3,000 to $6,000 per month on average, though some facilities cost more. You pay the facility directly each month. Some families use a combination: they pay out of pocket until assets run down to Medicaid limits, then switch to Medicaid.
The difference between assisted living and skilled nursing care
The line between assisted living and skilled nursing care is important because Medicare pays for one and not the other. Here is what separates them:
| Assisted Living | Skilled Nursing Care |
|---|---|
| Help with bathing, dressing, meals, medication reminders | Medical care: wound care, IV therapy, physical therapy, catheter care |
| You live in your own apartment or room | You live in a medical facility with nursing staff on site |
| Medicare does not pay | Medicare pays for up to 100 days after a hospital stay |
| Medicaid may pay in your state | Medicare and Medicaid both pay |
Some people need both at different times. You might spend three weeks in a skilled nursing facility after surgery, then move to assisted living once you can manage with personal care help instead of medical care.
Planning ahead if you think you will need assisted living
If you are thinking about assisted living in the future, start by understanding your state's Medicaid rules now. Contact your state Medicaid office or 211 to learn the income and asset limits. If you are above the limits, you have time to plan — some people work with an elder law attorney to understand how to structure their finances, though this is a specialized area and not all attorneys do it.
If you have a long-term care insurance policy, review it now to see what it covers. If you do not have one and think you might want it, know that policies are easier to get and less expensive when you are younger and healthier. If you are already retired or have health conditions, the cost may be high or you may not may have access to.
Visit assisted living facilities in your area and ask about their costs, whether they accept Medicaid, and what services are included. Costs and policies vary, and it helps to know your options before you need to move quickly.
Frequently Asked Questions
Can Medicare pay for assisted living if I have a medical condition?
No. Medicare does not cover assisted living based on any medical condition. If you need skilled nursing care — wound care, therapy, medical monitoring — Medicare covers that in a nursing home, not an assisted living facility. If you need only personal care help, Medicare does not pay, regardless of your health.
What if I move to assisted living after Medicare stops paying for my nursing home?
When Medicare stops paying for skilled nursing care, you must pay for any continued care out of pocket or through Medicaid if you may have access to. Some people stay in the nursing home and pay privately; others move to a less expensive assisted living facility. Talk to the facility's social worker about your options before Medicare coverage ends.
Does Medicare Advantage cover assisted living?
Medicare Advantage plans (Part C) follow the same rules as Original Medicare: they do not cover assisted living. Some Advantage plans offer supplemental benefits like transportation or meal delivery, but not the cost of living in an assisted living facility itself.
Can I use my Medicare Savings Account to pay for assisted living?
A Medicare Savings Account is not a real account you own — it is a Medicaid program that pays your Medicare premiums and copays. It does not give you money to spend on assisted living. You would need to pay for assisted living through other means: out of pocket, Medicaid, long-term care insurance, or Veterans benefits.
How do I know if an assisted living facility accepts Medicaid?
Call the facility directly and ask. You can also contact your state Medicaid office or 211, which can tell you which facilities in your area are certified to accept Medicaid. Keep in mind that a facility may be certified but have no open beds for Medicaid residents, so ask about current availability.