Understanding What Medicare Covers for Assisted Living
Medicare is a federal health insurance program in the United States primarily for seniors ages 65+ (and their spouses) who paid into it throughout their working years.
Medicare is divided into Parts A, B, C, and D. Generally if an individual has parts A, B, and D they have coverage for hospital stays, skilled nursing, hospice care, doctor’s visits and preventative care, and prescriptions. Medicare does not cover the cost of long-term assisted living. They cover a short-term skilled nursing stay in some cases, but not long-term residential care.
Does Medicare Cover Any Assisted Living Costs?
Medicare may cover some of the costs associated with an assisted living facility for a short term stay following a qualifying hospital admission. Short-term care in a skilled-nursing facility is designed with the goal of rehab and recovery for the patient, usually addressing an acute situation. Residential care is usually permanent with a focus on long-term support.
Medicare Advantage, sometimes called Medicare Part C, combines the benefits of Parts A and B and sometimes Part D into one policy offered by a third party insurance provider. While Medicare Part C does not cover residential costs associated with assisted living, it may cover medical expenses while residing in the facility such as doctor’s visits, preventative care, and prescription medication.
Why Medicare Doesn’t Fully Cover Assisted Living
Medicare was created in 1965 to provide health insurance for older adults, focusing on acute, short-term medical needs rather than long-term custodial care. Policymakers aimed to address the financial burden of medical care, not ongoing assistance with daily living. At the time, long-term care was seen as a family or state responsibility, with Medicaid to assist low-income individuals needing such care. Political and budgetary concerns also shaped the exclusion, as including long-term care in Medicare would have dramatically increased costs. This division remains today, leaving long-term care primarily outside Medicare's scope. For families whose income levels or assets fall above Medicaid’s threshold, this can leave a gap in the ability to pay for needed care.
Alternative Payment Options for Assisted Living
Medicaid Assistance for Long-Term Care
Seniors must have an income below a threshold, which does vary by state. In many states the limit is around $2900 per month as of 2025. An individual can have no more than $2000 in assets ($3000 for a couple), except for their primary residence, one vehicle, and some personal belongings. Not all states cover assisted living through Medicaid.
Many states have programs that cater to low-income seniors. In the State of Florida, Elder Affairs is an organization that has compiled many resources to help with these costs.
Veterans Benefits That May Help Pay for Assisted Living
Some veterans and spouses qualify for care benefits through the Veterans’ Administration. Individuals who qualify for the VA Pension may also be eligible for Aid & Attendance if they meet one of the following criteria: require help with daily living, are bedridden due to illness or injury, live in a nursing home due to physical or mental incapacity, or have severely limited eyesight.
Long-Term Care Insurance
Long-term care insurance helps cover services Medicare excludes, such as assistance activities of daily living. When choosing a policy, consider daily benefit amounts, inflation protection, elimination periods, and coverage duration to ensure adequate coverage for future care needs.
How to Maximize Medicare Benefits for Assisted Living Needs
Enrolling in Medicare Advantage Plans
Medicare Advantage (Part C) plans are offered by private insurers and combine Original Medicare (Parts A and B), often including prescription coverage and extra benefits. Some of the extra benefits often include vision and dental, some in-home care, transportation to medical appointments, some coverage for adult daycare or meal delivery.
When shopping for these plans, it is important to make sure preferred medical providers and hospitals are in network, review coverage for supplemental care such as home healthcare, and compare associated out of pocket costs.
Utilizing Medicare’s Home Health Services
Medicare covers home care only for temporary skilled nursing care for individuals who are homebound. There is no coverage for assistance with activities of daily living. These services can complement home health care, such as Senior Helpers provides, since it does not usually include skilled nursing services.
Preventive Services Covered by Medicare
Medicare covers the costs associated with preventative medical care. This would include annual check-ups, blood work, screenings, and vaccinations. This reduces overall health care costs for seniors.
FAQs About Medicare and Assisted Living
Does Medicare pay for home health care?
Medicare covers home care only for temporary skilled nursing care for individuals who are homebound.
Does Medicare cover assisted living in Florida?
Medicare does not. Florida Medicaid will cover care services in assisted living facilities, but not room and board.
What requirements must be met for Medicare to cover care costs?
Medicare will only cover the expenses of assisted living or home care that are related to an acute situation requiring temporary skilled nursing care.
Does Medicare pay for a home assistant?
The only in-home assistance medicare covers is temporary skilled nursing care for homebound individuals.
Tips for Planning Assisted Living Costs Early
It is vital to plan ahead for the costs of assistance later in life, whether that is obtaining long-term care insurance or investing in an account to use for future care expenses.
The following tools and resources may be helpful for the planning process:
- https://www.ltcfeds.gov/tools/cost-of-care
- https://www.nia.nih.gov/health/caregiving/services-older-adults-living-home
- https://www.loc.gov/nls/services-and-resources/informational-publications/resources-senior-citizens-families/
Partnering with Senior Helpers for Personalized Care Solutions
Senior Helpers has many resources to help families navigate this season. An in-home care assessment is an excellent starting point for planning care for yourself or a loved one. Schedule an in-home care assessment with Senior Helpers today!