Does Medicare Cover Assisted Living?

Over 3.5 million seniors live in Assisted Living homes or facilities in the U.S. Find out if Assisted Living is covered by Medicare.
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Introduction

Does Medicare cover assisted living costs?  According to the National Center for Assisted Living (NCAL) there are more than 835,000 Americans currently residing in assisted living communities.  If you (or your parents) are considering assisted living, you may be wondering if Medicare will help cover the costs so let’s find out.

What is Assisted Living?

Assisted living is a residential setting designed to help various levels of medical and personal care needs for seniors or people with disabilities. This type of housing can range from individual rooms, apartments, or even shared rooms. These facilities aid residents in daily living while providing a home-like setting to promote the resident’s independence.

What services are available with Assisted Living?

Assisted living communities may vary in the services they offer. Common services that are provided in these communities are meals, medication monitoring, personal care like getting dressed and bathing, housekeeping, emergency care, certain medical services, and social and recreational activities.

Does Original Medicare Cover Assisted Living Costs?

Neither Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance) will cover assisted living costs. Original Medicare typically only pays for things that are medically necessary and will therefore not cover day-to-day services and related costs for assisted living, long-term care, custodial, or in-homes.

Original Medicare may cover expenses for short-term home health care or care received at a Skilled Nursing Facility (SNF) after a ‘qualifying hospital stay’ (typically defined as a hospital stay where you spend at least 3 days as an inpatient) where it is deemed medically necessary that you need that care and the care is delivered by specially trained medical staff.

Does Medicare Advantage Cover Assisted Living Costs?

Medicare Advantage plans (also known as Part C coverage) are health insurance plans provided by private health insurance companies. These plans are legally required to provide the same coverage as Original Medicare Parts A and B, however, many Part C plans offer additional benefits that Original Medicare does not such as dental and vision coverage as well as non-medical in-home care services, making them an attractive option to many retirees.

Medicare Advantage plans do not cover assisted living costs. However, in recent years, the Centers for Medicare and Medicaid Services (CMS) has relaxed rules to allow Medicare Advantage plans to provide additional supplemental benefits such as:

  • Non-skilled in-home care services
  • Adult daycare
  • Home modifications
  • Non-emergency transportation
  • Telehealth Services

These supplemental services may enable seniors who are potentially considering assisted living to reconsider if they are able to safely live at home and/or if assisted living facilities are not truly needed or wanted.

The availability of these supplemental benefits depends on your service area. However, insurance companies are continually improving benefits so you should check your options every year.

Does Medigap Cover Assisted Living Costs?

Medigap (otherwise known as Medicare Supplement) is insurance provided by private health insurers to supplement Original Medicare. Given this, Medigap policies do not cover assisted living costs unless it is medically necessary and therefore a Medicare-qualified expense.

Much of the long-term care available for seniors are not covered by Medicare, which leads many to think that this is a “gap” that Medigap will help fill, but this is not true. Even the best and most comprehensive Medigap plans do not cover long-term care for seniors. The most these plans will be able to cover is medically necessary temporary Skilled Nursing Facility (SNF) or home health care that is related to an inpatient hospital stay.

So How Can You Pay for Assisted Living?

  • It is possible to purchase long-term care insurance which will typically cover custodial care. Coverage will vary from policy to policy, but assisted living expenses are usually covered by this type of insurance.
  • You may also choose to pay for assisted living through personal finances. Selling significant assets, such as a home no longer needed, may provide extra funds that can help pay for their new apartment.
  • Home equity loans are another avenue for financing senior living while you are in the process of selling a senior’s home or liquidate other assets to pay for assisted living.
  • As mentioned earlier in this article, some Medicare Advantage plans will pay for in-home support. If assisted living is not absolutely necessary the supplemental benefits may be able to help.

Final Words

To review, Medicare (including Medicare Advantage and Medigap policies) generally does not cover assisted living costs and is targeted to cover medically necessary services and supplies.  However, the CMS has relaxed rules to allow Medicare Advantage plans to offer supplemental benefits such as non-skilled in-home care services which may allow those considering assisted living but do not truly need to consider using these benefits to continue to age in place.

At CoverRight, we’re here to help you find the right coverage that you deserve.   Reach out today and start finding the best Medicare plan for you.

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