Is assisted living covered by Medicare?

Courtesy Vista Springs Assisted Living

By Vista Springs Assisted Living


When it comes to the costs associated with senior living options like an assisted living community, there are a lot of questions that family members ask themselves when finding a home for a loved one. Things may be on your mind like what are the costs associated with increased care needs, how much is the monthly room and board, and if luxuries are an additional charge. 


Finding senior loved ones the best senior living community depends on knowing the answers to all of these questions and more. When thinking about ways to help finance assisted living, another common question is if Medicare, or senior health insurance available to everyone over 65, will help pay for the costs of assisted living.

What is assisted living?

So what is assisted living? How is it different from other types of residential senior living communities, like a nursing home or a senior retirement community? The biggest difference between assisted living and other senior living options is that assisted living, as the name suggests, assists seniors who need help with activities of daily living, or ADLs, while still offering them plenty of independence. 


Nursing homes, which are also an example of a senior living community that offers care services for seniors, have very limited independence due to the high level of care that residents typically need. On the other hand, senior retirement communities are for retirees who do not yet need any help with ADLs. 


Assisted living is a perfect medium between the two. Assisted living offers residents plenty of independence in their lives and the ability to make their own decisions, while still providing care services and ADLs assistance for things like:

  • Medication management
  • Housekeeping and cleaning
  • Laundry
  • Meal preparation
  • Money management
  • Bathing and personal care
  • Appointment and schedule keeping
  • Standing up and other mobility needs

What Medicare covers

To make a long answer short, Medicare does not cover assisted living costs. Medicare, for the most part, does not pay for any type of long-term residential care, including nursing homes and assisted living communities, so if one of these is the best option for your loved one, you will need to find a different way to pay than through their Medicare plan. 


Medicare will sometimes pay for a short-term stay in a skilled nursing facility or for some home health care options, but senior living communities like assisted living are not included in Medicare plans. This can pose a problem for many elders, especially as the senior population often needs some sort of residential care community as they continue to age. 

Other payment options

While Medicare doesn’t help pay for assisted living, there are some other payment options that can give your loved one assistance in covering the costs of a senior living community.

Long-term care insurance

Most long-term care insurance policies will cover the expenses associated with senior living, including assisted living costs. While the popularity of the traditional version of these plans has decreased over time, there are new “hybrid” plans that might be a good investment for your loved one. 

Life insurance policies

Some life insurance policies will cover assisted living costs, but it varies from plan to plan. While most of us might think that life insurance is only paid out after a death, they can offer payouts to seniors still living if they meet the plan’s qualifications. 

Veterans benefits

Often times there are VA benefits that will help pay for assisted living or other residential care options if your loved one served the country. Check with your loved one’s local VA chapter for more information. 

Medicaid

If your loved one doesn’t have any savings, or had a low income while they were working, they might qualify for Medicaid, a government program made to help cover the costs of healthcare for those in dire financial circumstances. Medicaid coverage is determined state by state, so it may or may not help depending on where your loved one lives. 

Out-of-pocket

If your loved one has saved enough money throughout their life, they may be able to afford assisted living costs from their savings. Planning ahead is key for this payment method, and things like waiting lists, community “shopping”, and retirement income plans are important for your loved one. 


Reprinted with permission from Vista Springs Assisted Living.




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