You may be considering assisted living because someone you love needs more help than you can comfortably manage at home. Many families reach this moment with a mix of worry and hope.
You want safety and comfort in a place that feels like home. At the same time, you are concerened whether Medicare will cover the expenses. The rules around Medicare coverage may feel confusing, especially when you hear different answers from different sources.
In this guide, we will explain everything in a simple and practical way, so you can make confident decisions for your family.
What Is Assisted Living and How Is It Different From Nursing Homes?
As Medicare treats the two types of care differently, you need to understand the difference between assisted living and nursing homes.
Assisted living provides a home-like environment to your loved ones where they can live independently while receiving help with daily care. They get help in bathing, dressing, medication reminders, or mobility assistance. There are private or semi-private rooms for residents with shared meals and daily activities that keep them connected.
A nursing home is different. It provides medical oversight if your family member needs round-the-clock skilled nursing care. If someone is recovering from a major illness or requires continuous clinical attention, a nursing home is a better option for them.
Because of the higher medical focus, in nursing homes, people feel more clinical, whereas assisted living feels like home.
Will Medicare Help Pay for Assisted Living
If you have chosen an assisted living facility for your loved one, you may now be wondering whether Medicare will help cover the cost. It is an important question, and the answer is that Medicare will not pay for assisted living. It categorizes assisted living as “custodial care,” which means support with daily living tasks rather than medical treatment.
Medicare pays for approved medical care, but not for:
- Room
- Board
- Meals
- Personal care services in an assisted living setting.
Since assisted living is all about daily support and not clinical treatment, it does not qualify for Medicare coverage.
Even though Medicare does not cover the cost of living in an assisted living community, it still supports residents with medical needs. This is where Medicare Part A and Medicare Part B come in.
Medicare Part A
Medicare Part A covers finances related to hospital stays and short-term skilled nursing when strict medical conditions are met. That means if your family member has been in the hospital and needs daily skilled therapy afterward, Part A may cover a temporary stay in a skilled nursing facility.
This benefit is short-term and focused on medical rehabilitation. It is different from assisted living, and does not cover room and board inside an assisted living community.
Medicare Part B
Medicare Part B continues to support someone even after they move into assisted living. It pays for:
- Doctor appointments
- Preventive screenings
- Outpatient treatment
- Durable medical equipment
- Therapy ordered by a physician.
These medical benefits stay active no matter where your adults live. While Part B cannot cover the cost of living in the community, it lowers ongoing medical expenses.
Together, Part A and Part B take care of medical needs, but they do not pay for daily personal care or residential costs in assisted living.
Will Medicare and Medicaid Pay for Assisted Living Together?
Some families wonder if combining Medicare and Medicaid can give them more support in case of assisted living. Medicaid is a state and federally funded program that provides health coverage for people with limited income and resources. Eligibility and benefits vary by state, which affects how much help a person can receive.
Medicare will not pay for assisted living costs. However, Medicaid can help with some services that your loved ones get in assisted living communities through state waiver programs. But these waivers only support some of the personal care services, like laundry or recreational support services etc. They do not cover the cost of housing or meals. The resident or their family must cover these charges themselves.
In short, Medicare covers medical care, and Medicaid can help with care-related services. But each state sets its own rules, so you should research local programs early in the planning process.
3 Alternative Ways to Pay for Assisted Living
While Medicare will not pay for assisted living, you still have several options to manage the cost of care.These options include:
1. Veterans Benefits
Veterans or surviving spouses may qualify for financial help through the Department of Veterans Affairs (VA). One of the most helpful programs is the Aid and Attendance benefit. It provides monthly payments to veterans who need support with daily activities. They can use this money to pay for personal care services in assisted living.
If your family has a military background, this benefit can make assisted living more affordable for your loved ones.
2. Long Term Care Insurance
Long-term care insurance is another good option to pay for senior care, including assisted living. Some policies cover the full cost of assisted living, while others include specific services, like personal care or therapy.
Since each policy works differently, you should review the details to know exactly what is covered and how much financial support you can expect.
3. Private Funds
Families can also use personal resources to pay for assisted living. These may include:
- Savings
- Retirement income
- Proceeds from selling a home
- Converting a life insurance policy.
Explore these options and create a clear financial plan to remain stress-free during this important transition.
Conclusion
Medicare plays an important part in medical care for older adults, but it does not cover assisted living. It may feel discouraging at first, especially when you want safety and comfort for someone you love.
Once you understand what Medicare covers and what it does not, you can explore Medicaid options, benefits for veterans, long-term care insurance, and private resources to help release your financial burden.
If you are searching for a place for your loved ones where compassion feels real and family truly matters, St. Francis Villa is ready to welcome you.
