Medicare does not pay for assisted living as a general benefit
Medicare covers skilled nursing care in a facility, but assisted living is not the same thing. Assisted living provides help with daily tasks like bathing, dressing, and meals — but not medical care. Medicare does not cover these personal care services, whether you receive them in an assisted living facility, your home, or anywhere else.
If you need only help with daily living tasks and no skilled medical care, Medicare will not pay. You would pay for assisted living out of pocket, through Medicaid (which does cover it in most states), long-term care insurance, or family support. The distinction matters because many people assume Medicare covers any care in a facility, when in fact it covers only specific medical services.
Key Takeaways
- Medicare covers skilled nursing care in a facility only after a hospital stay of at least three days, and only for up to 100 days per benefit period.
- Assisted living facilities provide personal care and supervision but not skilled nursing, so Medicare does not cover the cost of living there.
- If you need both skilled care and personal care, you may may have access to for Medicare-covered skilled nursing for part of your stay, then pay out of pocket for assisted living services after that coverage ends.
- Medicaid covers assisted living in most states, but you must meet income and asset limits, and coverage varies by state.
- Long-term care insurance and Veterans benefits may cover assisted living if you purchased a policy or served in the military.
What Medicare actually covers in a facility
Medicare covers skilled nursing care in a facility, which means medical care provided by nurses or therapists under a doctor's orders. This includes wound care, physical therapy, occupational therapy, speech therapy, and medication management. You must have been in a hospital for at least three consecutive days before Medicare will pay for skilled nursing in a facility, and the care must be for the same condition you were hospitalized for.
Medicare pays for up to 100 days in a skilled nursing facility per benefit period. For days 1 through 20, Medicare covers all costs. For days 21 through 100, you pay a daily coinsurance amount (this amount changes each year). After day 100, you pay the full cost yourself. The facility must be Medicare-certified for this coverage to explore.
Many assisted living facilities do have a skilled nursing unit on-site, which means you could receive Medicare-covered skilled care there. However, once you no longer need skilled care — once your therapy ends or your wound heals — Medicare stops paying, and you would then pay out of pocket for the assisted living services in that same facility.
The difference between skilled nursing and assisted living
Skilled nursing care is medical care that requires a licensed nurse or therapist. Assisted living is personal care — help with bathing, dressing, grooming, toileting, and meals. A person in assisted living may have a nurse on staff for emergencies or to manage medications, but the primary service is not medical.
Medicare distinguishes between these two because skilled care is medically necessary and time-limited, while assisted living is ongoing support with daily living. If you move to an assisted living facility because you need help with bathing and meals but do not need physical therapy or wound care, Medicare will not pay. You would cover this cost yourself or through another source.
Some people need both. For example, you might spend 30 days in a skilled nursing facility recovering from surgery and doing physical therapy (Medicare pays), then move to assisted living in the same building for ongoing personal care (you pay out of pocket or through Medicaid).
Medicaid coverage of assisted living
Medicaid, the joint federal-state program for low-income people, covers assisted living in most states. However, Medicaid rules vary significantly by state — some states cover assisted living broadly, while others cover it only in specific situations or not at all. You must meet income and asset limits to may have access to for Medicaid, and these limits also vary by state.
To find out whether your state covers assisted living through Medicaid and what the income and asset limits are, contact your state Medicaid office or call 211 (a free referral service). You can also ask the assisted living facility itself whether it accepts Medicaid, because not all facilities do even if your state covers it.
Medicaid typically requires you to spend down your assets to a certain level before coverage begins. This means using your savings and resources to pay for care until you reach the state's asset limit. The rules are complex, and it is worth speaking with a Medicaid caseworker or an elder law attorney before making decisions about your assets.
Other sources that may cover assisted living
Long-term care insurance covers assisted living if you purchased a policy before you needed care. The amount and length of coverage depend on the policy you bought. If you have a policy, contact the insurance company to understand what it covers and what you need to do to file a claim.
Veterans benefits may cover assisted living if you or your spouse served in the military. The Aid and Attendance benefit can help pay for assisted living for may be able to access veterans and surviving spouses. Contact the Department of Veterans Affairs or a Veterans Service Officer to learn whether you may have access to.
Supplemental insurance (Medigap) policies do not cover assisted living. These policies help pay for costs that Medicare does not cover, such as copayments and deductibles, but they do not extend to non-medical services like assisted living.
Planning ahead if you think you will need assisted living
If you are thinking about assisted living now or in the future, start by understanding what you actually need. Do you need help with daily tasks only, or do you also need medical care? The answer determines what Medicare will cover and what other resources you should explore.
If you think you may need assisted living in the next five to ten years, ask your doctor whether long-term care insurance makes sense for you. Policies are less expensive when you are younger and healthier. If you are already in your 80s or have health problems, insurance may not be available or affordable, and you would need to plan through Medicaid, savings, or family support instead.
Talk with your family about your preferences and your finances. Assisted living costs vary widely by location and facility, but many cost $3,000 to $6,000 per month or more. Understanding your options now — Medicare, Medicaid, insurance, savings, and family help — makes the decision easier if the time comes.
Questions to ask your doctor or social worker
Before you move to assisted living, ask your doctor or a hospital social worker these questions: Do I need skilled nursing care, or only help with daily tasks? If I need skilled care, how long will I need it? Once my skilled care ends, what level of personal care will I need? Is there a skilled nursing facility or assisted living facility that my doctor recommends?
If you are already in a hospital or skilled nursing facility and thinking about your next step, ask the social worker to help you understand what Medicare will cover and for how long. The social worker can also tell you about Medicaid in your state and help you connect with other resources.
Frequently Asked Questions
Can Medicare pay for assisted living if I live there permanently?
No. Medicare covers skilled nursing care only, and only for up to 100 days per benefit period after a hospital stay. If you live in assisted living permanently and do not need skilled care, Medicare does not pay. Medicaid may cover it in your state if you meet income and asset limits.
What if I need both skilled nursing and personal care at the same time?
Medicare covers the skilled nursing part. You would pay out of pocket for the personal care services, or Medicaid would cover them if you may have access to. Some facilities bill Medicare for skilled care and you or Medicaid for assisted living services simultaneously.
Does Medicare cover assisted living if I have a Medigap policy?
No. Medigap policies cover costs that Medicare does not cover, such as copayments and deductibles, but they do not extend coverage to services Medicare does not cover at all. Assisted living is not covered by Medicare, so Medigap does not cover it either.
How do I know if my state covers assisted living through Medicaid?
Call your state Medicaid office or dial 211 to speak with a referral specialist. You can also ask the assisted living facility whether it accepts Medicaid. Each state has different rules, so you need information specific to where you live.
What should I do if I cannot afford assisted living and do not may have access to for Medicaid?
Explore Veterans benefits if you served in the military, ask your family about financial help, and contact a local Area Agency on Aging (find yours through the Eldercare Locator at 1-800-677-1116). Some communities have subsidized housing or other programs that may help.