No. Medicare.gov says Medicare and most health insurance, including Medicare Supplement Insurance (Medigap), don't pay for long-term care, also called custodial care, and that includes the monthly cost of living in an assisted living facility. Medicare does still cover a resident's medically necessary care, like doctor visits, hospital stays, and covered home health or hospice services, the same as it would if they lived at home.
What is long-term care, and why doesn't Medicare cover it?
Medicare.gov describes long-term care as medical and non-medical care for people who have a chronic illness or disability. Most of it helps with the basic personal tasks of everyday life, sometimes called "activities of daily living," like bathing, dressing, and eating.
Medicare is health insurance for medical care. Help with daily living, room and board, and supervision fall outside what it pays for. Medicare.gov's long-term care page says "Medicare doesn't pay for long-term care" and that you pay all costs for most long-term care.
Medicare.gov also notes you can get non-medical long-term care at home, in the community, in an assisted living facility, or in a nursing home. The setting doesn't change the answer.
What does an assisted living bill usually include?
Prices and billing vary by facility. A monthly bill may include items like these:
- Rent or room and board.
- Meals.
- A "level of care" charge for help with daily tasks.
- Medication management.
- Extra services, like laundry or transportation.
None of these are Medicare charges, so they won't appear on a Medicare Summary Notice (MSN). Ask the facility for a written list of what's in the base rate and what costs extra, and how and when rates can change.
What will Medicare still pay for while my parent lives in assisted living?
Medicare coverage follows the person. A resident with Medicare still has:
- Doctor visits and outpatient care under Part B, which can include visits by doctors who come to the facility.
- Hospital stays under Part A.
- Skilled nursing facility care after a qualifying hospital stay, for a limited time, if they meet the rules.
- Home health services, if they qualify. Medicare.gov says these are covered when someone is homebound and needs part-time skilled care.
- Hospice care. Medicare.gov says you can usually get Medicare-approved hospice in your home or another facility where you live, like an assisted living facility or a nursing home.
- Prescription drugs through a Part D or Medicare Advantage plan.
These services will appear on an MSN or a plan's Explanation of Benefits (EOB), separate from the facility's monthly bill.
Why do families get confused about this?
A few reasons:
- Short-term skilled nursing care is covered, but long-term living isn't. After a hospital stay, Medicare may pay for a limited stay in a skilled nursing facility for rehab. That's a different benefit from assisted living.
- Bills arrive from many places. The facility bills monthly, while doctors, therapists, pharmacies, and home health agencies bill Medicare and send their own statements.
- Some care happens inside the facility. A therapist or doctor who treats your parent on site may bill Medicare as a separate provider. Ask the facility who bills for on-site care.
Who can help pay for assisted living?
Medicare.gov points to these options for long-term care costs:
- Medicaid. Medicare.gov says you may be eligible for long-term care through Medicaid if you meet your state's requirements. Medicaid programs vary by state, and coverage for assisted living may differ from coverage for nursing homes. Call your state Medicaid office to ask what it covers.
- Long-term care insurance. If your parent bought a private long-term care insurance policy, check what it pays for assisted living and how to file a claim.
- PACE (Program of All-inclusive Care for the Elderly). Medicare.gov describes PACE as a Medicare and Medicaid program available in some states. To join, a person must be at least 55, live in a PACE service area, need a nursing home level of care as certified by the state, and be able to live safely in the community with help from PACE.
Your parent's own savings and income may also help. For veterans, the U.S. Department of Veterans Affairs (VA) says it doesn't pay for rent in an assisted living facility but may pay for some extra services a veteran needs there. Ask the VA what your parent qualifies for. A State Health Insurance Assistance Program (SHIP) counselor can talk through Medicare and Medicaid questions for free. Find one at shiphelp.org.