Does Medicare Cover Assisted Living?

When people first come to us at Modern Care Homes looking for assisted living for their loved ones in Arizona, we often get asked about Medicare. Does it cover assisted living costs? It’s a little complicated, but there are programs to cover what Medicare doesn’t. Here’s a breakdown:

What Medicare Would Cover

1. Medical services needed while someone is living there. This would include doctor’s visits and physical therapy. In assisted living homes, this would also include any other medical appointments. 
2. If an assisted living home needs additional medical equipment by a new resident, it would be covered under Medicare. Think of safety bars in the shower or a wheelchair ramp.
3. For prescriptions needed, Medicare Part D or a Medicare Advantage Plan with drug coverage will cover the expenses. Do your research to see which programs cover what Medicaid doesn’t, including VA services. 
4. Long-term skill nursing care may be covered by Medicare Part A, but only for up to 100 days. This doesn’t include assisted living homes, but does cover a hospital stay. 

What Medicare Doesn’t Cover

1. Room and board costs aren’t covered by Medicare in an assisted living home, since those aren’t considered medical. To cover the costs of residing in an assisted living home, many residents will talk with their primary insurance provider, or use personal savings to help cover the costs. 
2. Custodial care, such as bathing, eating, and dressing, aren’t covered by Medicare. Basically, anything that’s a daily activity, but not a medical service, isn’t covered by Medicare. At Modern Care Homes, we provide these services in most of our homes, which is part of the package.

How to Supplement What Medicare Doesn’t Cover

1. Medicaid may help cover the costs of long-term care, and the eligibility is based on your income. This can very from state-to-state, so be sure to check locally for assisted living benefits.
2. Social Security Administration Programs, depending on your income and medical consition(s), can also cover some of these costs, especially if you’re receiving benefits like SSDI or SSI. 
3. Long-term care insurance plans through your private insurance, depending on the coverage you have. This can vary between plans, so read the fine print to check eligibility.

Making the decision to move into assisted living is a difficult one, with finances at the forefront of the decision making of where to go. Medicare can be a great benefit for patients who need it, supplemented by other various ways to pay the costs of living. Talk with your physicians to help decide which plans are best for you.