Does Medicare Cover Assisted Living Homes?

We field calls from potential clients/patients for our assisted living homes here in Arizona about Medicare on a weekly basis. Does it cover the costs? Most likely not. Here’s an explanation of Medicare, as well as its role in assisted living homes in Arizona.

What is Medicare?

For people over 65, Medicare is a federal health insurance program. There are rare instances of people under 65 being eligible, with limited ailments on the list. Medicare is there to help with medical costs, but it doesn’t cover things like long-term care. 

There Are Two Types of Medicare: Parts A and B

Medicare Part A: Known as “hospital insurance,” Part A covers hospital stays and skilled nursing facilities for those over 65. It may also help with the costs of home health care and hospice. For people under 65, eligibility can include ALS and kidney failure, among others.

Medicare Part B: This is “medical insurance,” for things like doctor visits, mental health services, outpatient care, home health service, outpatient prescriptions, and includes preventative services. It can even help with the cost of medical equipment like hospital beds and wheelchairs. 

How Does Medicare Factor Into Assisted Living Homes?

It doesn’t. Because Medicare is there to cover medical costs, services like assisted living homes aren’t covered. Assisted Living Homes are called “custodial care,” meaning help with everyday activities like bathing, medication management, and meal preparation.

But, if a patient needs skilled nursing care in an assisted living home, it may be covered by Medicaid. This is not a long-term solution, but can help offset the costs of a hospital stay. 

What Are Other Options if Medicare Doesn’t Cover the Cost?

Medicaid: While this won’t cover the room and board portion of living in an assisted living home, it will help cover the services offered, such as nursing care and personal care for patients. This can vary by state, so be sure to do your research on where you live to see if Medicaid will cover part of your expenses. 

Veterans Affairs: While the VA doesn’t cover costs like room and board at an assisted living home, there are other services for veterans, such as the Veteran Directed Care Program may include some home health care services.

State programs: In Arizona, the Arizona Long Term Care System is part of the state Medicaid program. While it doesn’t cover the room and board costs of an assisted living home, it may cover some in-home costs necessary. Forbes created a list of each state’s benefits for Medicaid.

If you’re looking for ways to cut costs and utilize various insurance programs for assisted living homes, be sure to check with your state’s programs to get the most assistance for you or a loved one.