Original Medicare (Parts A and B) 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) 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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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.
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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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.
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 extra benefits and savings do you qualify for?
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.
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.
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While the answer to the question “Does Medicare pay for assisted living?” is no, Medicaid may help pay for assisted living, 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: