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Does Medicare cover the cost of assisted living facilities?

Medicare does not cover the cost of assisted living facilities. Medicare (part A) will cover the cost of short-term skilled care at a SNF (Skilled Nursing Facility), such as in (some) nursing homes. TCU's (transitional care units) may be another option. These are hospital-based skilled nursing units. Medicare requires a three-night hospital stay (no "observation days") to qualify, and there must be a need for skilled nursing or rehabilitation services. The first twenty days are covered fully. There is a co-payment for days 21 and beyond. Coverage is limited to 100 days at the most, but only as long as there continues to be a qualifying skilled need. Yes, this gets as complicated as it sounds.

Back to assisted living... these are facilities that are designed to provide just that - assistance in daily care activities. Although there is a nurse on staff (a Resident Care Coordinator) they are not present around the clock. They do not provide nursing care nor administer medications (although the facility may have a program that will prompt residents to take their meds). Depending on what is needed, a Visiting Nurse Association may provide skilled care within the facility. Some facilities may have a certain number of beds set aside for public assistance subsidy (Medicaid), but most are strictly by private payment. Residents who qualify, and wish to access their Medicare benefit for skilled services must transfer to a SNF.

Anthony Cirillo
Geriatric Medicine

The short answer is no. Here is a quick summary about how long-term care IS paid.

There are four ways to pay for long-term care.  People think that Medicare will carry the day.  It does for no more than eight percent of the population.  Medicare covers skilled nursing care only if you have been hospitalized for three consecutive days and then only for 100 days, 80 of which you pay a 20 percent co-pay. 

Next, self pay.  According to The Kaiser Commission on Medicaid and the Uninsured, self pay accounts for how 20 percent of people now pay for nursing home care.  Remember that is out of your pocket and out of your savings.  The average nursing home stay is 2.8 years, so if you have $200,000 or so socked away just for this, you should be OK. Average assisted living costs are $3,600 a month.

Medicaid is the primary payer for nursing home care though it is seaping into assisted living. Essentially after you exhaust your own personal funds, you might become eligible for Medicaid.  There are stipulations that I will not spell out here.  Suffice it to say that it is not as easy as just going broke to qualify.  And many people never want to consider this or think that it can be an option, a bit of stereotyping that Medicaid is a poor peoples’ program.  

There are VA benefits you can avail.

There are also life insurance policy options, called an Assurance Benefit, that converts your policy to funds you can use to pay for care.

Consult a professional! Repeat - consult a professional.

No. Medicare does not cover assisted living. While more states are starting to cover some services under Medicaid or other government programs, public payment is not common in the assisted living industry. State Medicaid agencies can provide information about eligibility and covered services.
Assisted living can be costly. About four out of five people pay for it out of pocket. Before you seriously consider assisted living as an option for your loved one, decide whether you and your loved one can afford it long-term. Keep in mind that the cost will rise over time because of standard cost-of-living increases. Also, expect monthly price hikes for extra services as needs change. 
Promotional materials for these residences commonly present fee information in general terms, so it’s crucial that your contract with the facility detail all of your payment obligations. Consider running the contract by a lawyer before signing.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.