Medicare does not pay for assisted living itself, but it may cover some of the medical services you receive there

Medicare Part A and Part B do not cover the room, board, or personal care that makes up assisted living — the help with bathing, dressing, meals, and medication reminders. Those costs are yours to pay, either out of pocket or through Medicaid (a different program). What Medicare does cover is skilled nursing care and rehabilitation services if you need them while living in an assisted living facility, but only if that facility is licensed to provide those services and Medicare determines the care is medically necessary.

The distinction matters because it shapes what you will actually pay. You might live in assisted living and have Medicare cover your physical therapy after a hip replacement, while you pay out of pocket for the staff member who helps you shower each morning. Understanding which costs fall where helps you plan your budget and know what to ask the facility about.

Key Takeaways

  • Medicare covers skilled nursing care and rehabilitation services in assisted living facilities, but only if the facility is licensed to provide them and the care meets Medicare's medical necessity standard.
  • Medicare does not cover room, board, meals, laundry, or personal care information — these are your responsibility or may be covered by Medicaid if you meet income and asset limits.
  • You must have been hospitalized for at least three consecutive days before Medicare will cover skilled nursing care in any facility, including assisted living.
  • Medicaid, not Medicare, is the program most likely to help pay for assisted living itself, though rules vary significantly by state.
  • The assisted living facility must be Medicare-certified or have a Medicare-certified unit for any Medicare coverage to explore.

What Medicare Part A covers in assisted living

Medicare Part A covers skilled nursing care and rehabilitation services in an assisted living facility, but only under specific conditions. You must have spent at least three consecutive days in a hospital (not counting the day you were discharged) within the 30 days before you move to the facility. This is called the three-day may have access to stay, and it is a hard requirement — Medicare will not waive it.

Once you meet that requirement, Medicare Part A covers the cost of skilled nursing services (such as wound care, injections, or catheter management) and rehabilitation therapies (physical therapy, occupational therapy, speech therapy) for up to 100 days per benefit period. You pay nothing for days 1 through 20. From day 21 through day 100, you pay a daily coinsurance amount, which changes each year. In 2024, that coinsurance was $200 per day, but you should confirm the current amount with your facility or Medicare.

The facility must be Medicare-certified for this coverage to explore. Not all assisted living facilities are. Some have a Medicare-certified skilled nursing unit within the building, which means you could receive Medicare-covered care in that unit while other residents in the facility do not have access to it. Ask the facility directly whether it is Medicare-certified or has a certified unit before you move in.

What Medicare Part B covers in assisted living

Medicare Part B covers doctor visits and outpatient services regardless of where you live, including in assisted living. If your doctor visits you at the facility, Medicare Part B covers that visit. If you go to an outpatient clinic for therapy or diagnostic testing, Part B covers it. These services are not specific to assisted living — they are the same coverage you would have anywhere else.

Part B also covers certain medical equipment and supplies if your doctor prescribes them: oxygen, wheelchairs, walkers, diabetic testing supplies, and similar items. The facility does not have to be Medicare-certified for Part B coverage to explore. You pay your Part B deductible (which varies by year) and then 20 percent of the approved amount for most services.

What Medicare does not cover in assisted living

Medicare does not pay for room and board — the cost of your room, meals, utilities, and housekeeping. It does not cover personal care information — help with bathing, dressing, grooming, toileting, or eating — unless that help is part of a skilled nursing service (for example, a nurse helping you bathe after surgery to protect a wound). It does not cover medication reminders or supervision, even though these are core services in assisted living.

These unpaid costs are what make assisted living expensive. Depending on the facility and your location, assisted living can cost between $3,000 and $6,000 per month or more. You pay this from savings, pensions, family support, or Medicaid — not Medicare.

How Medicaid differs from Medicare for assisted living

Medicaid, not Medicare, is the program most likely to help pay for assisted living itself. Medicaid is a joint federal and state program for people with low income and limited assets. It covers room, board, and personal care in assisted living facilities in many states, though the rules vary widely. Some states cover assisted living generously; others cover it minimally or not at all.

To learn whether your state's Medicaid program covers assisted living and what the income and asset limits are, contact your state Medicaid office or call 211 (a free helpline that connects you to local resources). You can also visit your state's Medicaid website. The process of explore for Medicaid is separate from Medicare and involves proving your income and assets meet the state's limits.

If you are already on Medicare and have limited income, you may also be may be able to access for Medicare Savings Programs, which help pay your Medicare premiums and cost-sharing. These programs do not pay for assisted living itself, but they reduce what you pay for Medicare coverage, which frees up money for other expenses. Your state Medicaid office can tell you whether you may have access to.

Planning for assisted living costs

Because Medicare covers only medical services and not the living expenses, you need a separate plan for paying the room and board. Start by contacting assisted living facilities in your area and asking for their current costs. Then explore whether you may have access to for Medicaid in your state — this is often the largest source of payment for people who cannot pay out of pocket. If you do not may have access to for Medicaid, ask the facility whether it offers a sliding scale based on income or whether it has a waiting list for Medicaid-covered beds.

Some people also use long-term care insurance, life insurance with a long-term care rider, or Veterans benefits (if they are a veteran or surviving spouse) to help pay for assisted living. Each of these has different rules and coverage amounts. A social worker at the facility or at your local Area Agency on Aging can help you understand which options might work for your situation.

What to ask the assisted living facility about Medicare

Before you move to an assisted living facility, ask these specific questions: Is the facility Medicare-certified, or does it have a Medicare-certified unit? If yes, what skilled nursing services and rehabilitation services does it provide? What is the daily coinsurance amount you will owe for days 21 through 100 of a Medicare-covered stay? Does the facility accept Medicare assignment (meaning it bills Medicare directly)? What happens to your room if you are hospitalized or transferred to a hospital for more than a certain number of days?

Also ask whether the facility has experience working with Medicare and whether it can explain your bill clearly. Some facilities are more experienced with Medicare billing than others, and that experience can make a real difference in getting your claims processed correctly and on time.

Frequently Asked Questions

Can I use Medicare to pay for assisted living if I was not hospitalized first?

No. Medicare Part A requires a three-day hospital stay within the 30 days before you move to the facility. Without that stay, Medicare will not cover skilled nursing or rehabilitation services in assisted living, even if you need them. If you are moving to assisted living without a recent hospitalization, you will need to pay out of pocket or use Medicaid if you may have access to.

What if I run out of Medicare coverage before I am ready to leave assisted living?

Medicare Part A covers up to 100 days per benefit period. If you still need skilled care after day 100, you pay the full cost yourself unless you have another source of payment, such as long-term care insurance or Medicaid. Talk to the facility's social worker about your options before your Medicare coverage ends.

Does Medicare pay for assisted living if I have a Medigap or Medicare Advantage plan?

Your supplemental coverage (Medigap) or Medicare Advantage plan may help pay your coinsurance and deductibles for Medicare-covered services, but neither type of plan changes what Medicare itself covers. Medicare still does not cover room and board or personal care. Check your plan's summary of coverage to see what it pays for skilled nursing care in assisted living.

Will Medicare pay if the assisted living facility is not certified?

No. The facility must be Medicare-certified or have a Medicare-certified unit for any Medicare coverage to explore. If you are considering a facility that is not certified, you cannot count on Medicare to cover skilled care there. Ask the facility about its certification status before you move in.

Can I switch from assisted living to a nursing home and use Medicare?

Yes, if you meet Medicare's requirements. You need a three-day hospital stay, and the nursing home must be Medicare-certified. Medicare covers skilled nursing care in a certified nursing home under the same rules as in assisted living — up to 100 days per benefit period, with you paying coinsurance from day 21 onward.