Does Medicare pay for assisted living?

Medicare is a federal health coverage program that doesn't pay for an assisted living community directly. However, in certain circumstances, Medicare may help pay for some assisted living costs for qualifying older adults who live in senior living communities. Currently, this program applies to: 

• Adults age 65 and older 

• People under age 65 who receive Social Security Disability Benefits 

• People of any age diagnosed with amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) or permanent kidney failure 

In these cases, Medicare covers medically necessary acute care, such as doctor visits, medications, and hospital stays. To plan accurately for your long-term care needs, make sure you understand the Medicare program and stay current on changes to what may or may not be covered.  

How much does Medicare pay for assisted living? 

It's important to know that Medicare doesn't pay for “custodial care,” which is most assistance with activities of daily living (ADLs). Instead, it covers limited, medically necessary skilled care for an illness or injury. Medicare pays only for medical treatment, not costs associated with room and board. For example, if you need long-term skilled care after a hospitalization and meet the qualifying conditions: 

• Medicare pays 100% of the cost for the first 20 days. 

• For days 21 through 100, you pay a daily copayment, and Medicare pays the remaining balance. 

• Medicare won't cover the cost of a skilled nursing facility stay after the 100th day.

In some cases, assisted living residents use Medicare to pay for ongoing long-term care services when they have medical conditions that may not improve. Examples include stroke, Parkinson's disease, ALS, multiple sclerosis, or Alzheimer's disease. Medicare may also cover hospice care for assisted living residents who have a terminal illness and are no longer seeking a cure.

If you live in an assisted living community and have Medicare prescription drug coverage, you'll receive covered prescriptions from a long-term care pharmacy that works with your plan.

For durable medical equipment and supplies, such as wheelchairs, hospital beds, oxygen, and walkers, Medicare will often cover a large portion of the cost, but you'll still need to pay the remainder. 

Assisted living residents with Medicare may also receive home medical services if they meet certain criteria:

• A doctor must certify that the resident needs specific home health services, such as skilled nursing visits, physical or occupational therapy, or speech-language pathology services. 

• A Medicare-certified agency must provide the care. 

• A doctor must certify that the resident is homebound and that travel to medical appointments isn't advisable for health reasons. 

How to find an assisted living community that accepts Medicare 

Whether an assisted living community accepts Medicare depends on its structure and services. Not every community accepts Medicare because it may not directly provide covered medical services. If you want to use Medicare to pay for medical care while living in an assisted living community, you'll need to confirm that the community has Medicare certification.

Confirm that Medicare covers the specific service you need by visiting Medicare's website and working with your doctor to create a health care plan. As you research and tour assisted living communities, check whether they employ the necessary health care professionals, such as skilled nurses and therapists, who can provide the services you need. 

When researching assisted living communities near you, ask whether they accept Medicare and how they structure payments. You'll need to separate medical expenses from personal care services and room and board fees. This may be easier if the community uses an “à la carte” payment model. If it uses an “all-inclusive” structure, ask whether it can still provide an itemized list of medical services. 

How to pay for assisted living with Medicare 

Once you or your loved one has chosen an assisted living community, the way Medicare payments are handled will depend on that community. The community may help coordinate payments or act as a liaison. When coverage applies, Medicare pays as it would if the medical services were provided in a doctor's office, hospital, or home.

To use Medicare benefits to cover eligible assisted living costs, you may need to show that the medical care was provided directly through the community. If your assisted living community accepts Medicare payments for medical care, it should provide an itemized list of services that clearly identifies which health care charges may qualify for coverage.

Other forms of government health coverage 

Other government-funded programs may also help pay for some long-term care services. Each program has specific rules about which services are covered, how long you can receive benefits, whether you qualify, and how much you'll pay out of pocket. Not every assisted living community accepts payments from these programs. Check with your plan and the community to confirm that you can use your benefits for the services you need.

Can Social Security help pay for assisted living in your state? 

In most states, qualifying older adults can use Optional State Supplements (OSS) to help pay assisted living costs. OSS is state-based financial aid provided in addition to federal Social Security benefits. Because OSS is a state-based program, coverage depends on your location. 

In most states, when applicable, OSS can be sent directly to an assisted living community to help pay for room and board. OSS amounts are calculated based on the individual's income. You can find more information about OSS benefits in your state. 

Can veterans benefits be used to pay for assisted living? 

The Department of Veterans Affairs (VA) pays for long-term care services for service-related disabilities and, in some cases, for other eligible veterans. This includes long-term care in assisted living communities, private homes, and skilled nursing facilities. Restrictions apply, so confirm whether VA benefits can cover your specific medical or personal care needs and whether the assisted living community accepts VA payments. Visit the VA's website to learn more about its care program options for older adults.

Does Medicaid cover assisted living costs? 

Medicaid is funded partly by the federal government and partly by the states. This means each state sets its own policies for using Medicaid funds in assisted living communities. Many states include nonmedical services under Medicaid programs, including personal care, homemaker assistance, medical equipment, and other services needed for care and housing.

Because placement in custodial skilled nursing care is costly, Medicaid sometimes provides vouchers that allow older adults to remain in assisted living communities. For more information, review a state-by-state summary of Medicaid personal care benefits.

Can state aid programs help with assisted living costs? 

In addition to programs offered nationally, many states provide their own forms of financial aid. The table below includes several examples:

• Alaska 

Senior Benefits Program 

Alaska Pioneer Homes 

• Colorado 

Old Age Pension Health and Medical Care Program (OAP) 

• Connecticut 

Congregate Housing Programs 

• Indiana 

Residential Care Assistance Program (RCAP) 

• Louisiana 

Permanent Supportive Housing (PSH) 

• Maryland 

Senior Assisted Living Group Home Subsidy 

Congregate Housing Services Program 

• Massachusetts 

Supportive Senior Housing Initiative 

• Minnesota 

Housing Support (formerly known as Group Residential Housing) 

• Nebraska 

Aid to the Aged, Blind, or Disabled 

• New York 

Assisted Living Program (ALP) 

• North Carolina 

State-County Special Assistance 

• New Jersey 

Congregate Housing Services Program (CHSP) 

• Ohio 

Residential State Supplement (RSS) Program 

• Rhode Island 

Long-Term Services and Supports (LTSS) Copay Program 

• Virginia 

Auxiliary Grants 

• Wisconsin 

Exceptional Expense Supplement for Members of Supplemental Security Income (SSI)