Does Medicare Cover Assisted Living?
Key Takeaways
- Original Medicare (Parts A and B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). does not cover the cost of most types of long-term care.
- Original Medicare may provide coverage options for short-term assisted care.
- Some Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans may offer coverage for long-term care.
- If you qualify for Medicaid or both Medicare and Medicaid, your state’s Medicaid program may have coverage for long-term care.
Medicare does not cover long-term care services, also known as custodial services with assisted living. Typically, Medicare does not pay for the cost of room and board or personal care in an assisted living facility. While Original Medicare and Medicare Advantage plans may cover some services associated with care provided in an assisted living facility, it’s important to note that room and board are not covered.
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How Much Does Assisted Living Cost?
The median cost for an assisted living facility in 2021 was $4,500 a month, Genworth’s annual Cost of Care survey estimated.
The cost of an assisted living facility can depend on its location. Some areas of the country can be more expensive than others. It’s helpful to compare available options before choosing.
How Much Does Medicare Pay for Assisted Living Facility?
Medicare does not cover any cost of assisted living. Keep in mind that Medigap and Medicaid may help with some associated costs, possibly including some short-term support that will be capped at a number of days or services. If you have a Medicare plan, typically, your room and board costs are not covered.
Does Medicaid pay for assisted living?
Some states have Medicaid programs and other services to help members live more independently, but states have different Medicaid thresholds. Medicaid assisted living isn’t guaranteed to be offered from state to state, and Medicaid rarely pays all costs. Individual states determine what costs and services they will cover for Medicaid enrollees.
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How do Seniors Pay for Assisted Living Facilities?
Most families cover assisted living costs using private funds, usually a combination of savings, Social Security benefits, pension payments and retirement accounts. When it comes to out-of-pocket room and board costs, long-term care can quickly become expensive.
Does Medicare Part B cover Assisted Living?
Medicare doesn’t cover assisted living. However, Original Medicare Part B may still cover some medical services that you need, such as outpatient care, and a Part D plan may help with prescription drugs for those in assisted living. In addition to those things, a Medicare Advantage plan may also cover things like dental and vision.
What Type of Insurance Pays for Assisted Living?
Insurance options for long-term care are minimal, and even the most comprehensive Medigap plans do not cover long-term care. Medigap does not cover assisted living for Alzheimer’s, personal care or adult daycare. Some programs may temporarily help pay for nursing home care, but the number of days and services is limited.
Some Veterans Affairs benefits may cover assisted living, and some private insurance companies offer long-term care policies.
A GoHealth licensed insurance agent can help you understand your options.
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How to Find Senior Assisted Living Near Me
The U.S. Department of Health & Human Services offers a state-by-state guide to assisted living resources. In many cases, the most comprehensive information about senior assisted living near me will come from your Area Agency on Aging.
Your healthcare provider or your plan may be able to help. If you believe a different provider or plan may be more beneficial to your situation, GoHealth can help you with coverage details and compare options.
Does Medicare Cover Assisted Living in My State?
Medicare does not pay for assisted living, but Medicaid may, depending on your state and circumstance. If you are eligible for Medicare, it is also possible to qualify for Medicaid (called dual eligibility) depending on your financial situation.
The American Council on Aging provides extensive information on how different states’ Medicaid program aligns with the needs of its long-term care population:
Does Medicare Cover Assisted Living in My State?
The state’s Medicaid programmay provide some support of assisted living for those who qualify.
Alaska
The state of Alaska has assisted living waiver programs that help residents living independently and residents with physical disabilities.
Arizona
Arizona will help cover medical and care services but does not cover assisted living costs associated with assisted living.
Arkansas
Arkansas offers options that can help qualified residents cover assisted living services.
California
Medi-Cal can help cover some residents’ assisted living with the Assisted Living Waiver. However, the waiver is not available statewide.
Colorado
Colorado offers a waiver program that helps residents with assisted living and care in an assisted living residence.
Connecticut
Connecticut’s Medicaid program offers the Home Care Program for the Elderly (CHCPE) for assisted living care.
Delaware
The state of Delaware assists residents in assisted living through the Diamond State Health Plan Plus program.
D.C.
The District of Columbia Medicaid program offers limited assistance through the Elderly and Persons with Disabilities Waiver.
Florida
Florida covers assisted living through the Statewide Managed Medicaid Care Long-Term Care Program.
Georgia
Georgia provides eligible residents with the Community Care Services Program, which includes assisted living services.
Hawaii
Hawaii’s Med-QUEST division of Medicaid will pay for nursing services in assisted living residences.
Idaho
Idaho’s Medicaid program provides programs that may pay for residents’ assisted living care at home or in assisted living.
Illinois
Illinois offers the HCBS Waiver for Supportive Living Facilities.
Indiana
Indiana offers the Aged and Disabled Waiver to residents that meet waiver requirements and are eligible for Medicaid.
Iowa
Residents of Iowa have waiver options, including the HCBS Elderly Waiver, that may provide help with assisted living.
Kansas
Medicaid in Kansas in conjunction with KanCare offers payment support for services at home or in assisted living.
Kentucky
Kentucky Medicaid provides limited support to elderly residents requiring assisted living.
Louisiana
The state’s Medicaid programmay provide some support of assisted living for those who qualify.
Maine
MaineCare offers Medicaid programs that help residents remain living in their home but does assist residents in assisted living facilities.
Maryland
Maryland Medicaid offers the Community Options Waiver, which will pay for assisted living.
Massachusetts
MassHealth provides the Personal Care Attendant program to cover personal care for residents in assisted living.
Michigan
Assisted living services in Michigan may be covered by the Choice Waiver Program.
Minnesota
Minnesota residents have waiver options for assisted living through Medicaid, including the Elderly Waiver and the Community Access for Disability Inclusion Waiver.
Mississippi
Mississippi provides residents with a Medicaid Waiver to help people living in assisted living residences.
Missouri
Missouri’s Medicaid program covers the cost of personal care for qualified individuals through its Aged and Disabled Waiver.
Montana
Montana’s Medicaid program provides the Home and Community Based Services Waiver to cover the cost of care services in assisted living.
Nebraska
Nebraska offers residents the Aged and Disabled Medicaid Waiver.
Nevada
Nevada covers personal care in assisted living residences. Another option for disabled adults of any age is the WIN Waiver.
New Hampshire
New Hampshire’s Medicaid program pays for assisted living.
New Mexico
New Mexico’s Medicaid program manages the long-term care and assisted living programs that may help residents with their care.
New Jersey
New Jersey has a Medicaid managed care program, which includes assisted living.
New York
New York offers the Assisted Living Program (ALP). Personal care provided under Managed Long Term Care can be provided to persons residing in assisted living, the Consumer Directed Personal Assistance program.
North Carolina
North Carolina’s Medicaid State Plan Personal Care option provides personal care assistance in assisted living.
North Dakota
North Dakota residents have the option of the State Plan Personal Care regardless of the living situation (excluding nursing homes).
Ohio
Ohio offers an Assisted Living Medicaid Waiver program. The waiver pays for services but not room and board.
Oklahoma
Oklahoma Medicaid’s ADvantage Waiver Program covers services in assisted living. Under the Medicaid State Plan, personal care may be covered in assisted living.
Oregon
Oregon offers care services as a benefit and the locations include home, adult foster care, independent living or assisted living communities.
Pennsylvania
The state’s Medicaid programmay provide some support of assisted living for those who qualify.
Rhode Island
Rhode Island has a program not associated with Medicaid, called SSI Enhanced Assisted Living, that provides funds toward the cost of assisted living.
South Carolina
South Carolina Medicaid covers assisted living as a benefit under the Community Choices Waiver.
South Dakota
South Dakota’s HOPE Waiver covers services in assisted living communities.
Tennessee
TennCare helps participants that wish to reside in assisted living communities by paying for nursing and personal care services in those communities.
Texas
Texas Medicaid will cover the cost of services provided in an assisted living community through the state’s STAR PLUS program. The cost of room and board is not included.
Utah
Utah Medicaid pays for services in assisted living residences through the New Choices Waiver.
Vermont
The Choices for Care Medicaid Waiver operates under the Global Commitment to Health Waiver and pays for services in non-nursing home, residential care facilities.
Virginia
The state’s Medicaid programmay provide some support of assisted living for those who qualify.
Washington
Washington has Medicaid waivers and programs that provide help for residents in assisted living or adult family care.
West Virginia
West Virginia will pay for personal care at home or in assisted living but the state’s program does not cover rent.
Wisconsin
In a limited capacity, Wisconsin provides services to residents that live in assisted living communities through the Family Care program.
Wyoming
Wyoming Medicaid offers the Community Choices Waiver to pay for personal care and nursing services for residents in assisted living. The waiver does not cover room and board.