Medicare and Assisted Living - What Medicare Covers, What It Doesn't and What Else Seniors Need

Many families assume Medicare will help pay for assisted living, and they're often surprised to learn how limited that coverage is.

Medicare still plays a big role for people who live in assisted living, though: it covers doctor visits, hospital care, prescriptions and many services residents use every day. This guide explains what Medicare covers when you live in assisted living, what it doesn't, what other coverage seniors with Medicare Parts A and B may need, and where to get free help during Medicare Open Enrollment.

Does Medicare Cover Assisted Living?

Original Medicare doesn't pay for the cost of living in an assisted living community. That includes rent or room and board, meals, and custodial care, which is help with everyday activities such as bathing, dressing and taking medications.

Medicare Advantage plans generally don't cover assisted living room and board either, though some offer limited extra benefits for things like in-home support or meals after a hospital stay. If you have a Medicare Advantage plan, ask what supplemental benefits it includes.

What Medicare Does Cover When You Live in Assisted Living

Your Medicare benefits continue no matter where you live. Residents of assisted living can still use:

• Part A hospital coverage for inpatient hospital stays, and for skilled nursing facility care for a limited time after a qualifying hospital stay
• Part B medical coverage for doctor visits, outpatient care, preventive services, lab tests, physical and occupational therapy, and durable medical equipment such as walkers and wheelchairs
• Home health care, such as part-time skilled nursing or therapy, if you qualify, delivered right in your assisted living apartment
• Hospice care, which can also be provided in assisted living
• Part D or Medicare Advantage drug coverage for prescriptions

I Have Medicare A and B. What Else Do I Need?

Parts A and B leave some important gaps. Most people add one or more of these:

• Prescription drug coverage. A standalone Part D plan, or a Medicare Advantage plan that includes drug coverage. Going without drug coverage when you're first eligible can lead to a lasting late-enrollment penalty.
• A Medicare Supplement (Medigap) policy, which helps pay deductibles and coinsurance under Original Medicare. The best time to buy one is during your Medigap Open Enrollment Period, the six months after you're 65 and enrolled in Part B, when insurers generally can't deny you or charge more for health conditions.
• Or a Medicare Advantage plan instead of Original Medicare, which often includes drug coverage and extras like dental, vision and hearing benefits, but usually uses a provider network.
• Dental, vision and hearing coverage, which Original Medicare generally doesn't include for routine care.

There isn't one Medicare plan that covers everything. Each option balances premiums, out-of-pocket costs, provider choice and extra benefits differently.

Other Ways to Pay for Assisted Living

• Medicaid. Many states have Medicaid waiver programs that help pay for care services in assisted living for people who qualify financially and medically, though they usually don't cover room and board.
• Veterans' benefits. Certain VA pension benefits can help eligible veterans and surviving spouses pay for care.
• Long-term care insurance often covers assisted living, depending on the policy.
• Personal savings, Social Security and home equity pay for most assisted living stays.

If a family member needs help at home before moving, our guides to home care aides and finding private caregivers explain those options.

Medicare Eligibility and Enrollment

Most people become eligible for Medicare at 65. If you're still working at 70 or later and have employer coverage, you may be able to delay Part B without a penalty through a Special Enrollment Period, but check the rules before you drop or delay any coverage.

Medicare Open Enrollment runs from October 15 to December 7. During this time you can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or change drug plans, with changes taking effect January 1.

Where to Get Free Medicare Help

• Speak to a Medicare representative at 1-800-MEDICARE (1-800-633-4227).
• Contact your State Health Insurance Assistance Program (SHIP) for free, unbiased one-on-one counseling.
• Ask about Extra Help and Medicare Savings Programs if your income is limited. These can lower drug costs and premiums.

Frequently Asked Questions

Will Medicare pay for assisted living if I need help with daily activities?

No. Help with daily activities is considered custodial care, which Medicare doesn't cover in assisted living. Medicaid, VA benefits or long-term care insurance may help.

Can I keep my doctor if I move into assisted living?

Usually, yes. With Original Medicare you can see any doctor who accepts Medicare. With Medicare Advantage, check that your doctors are in the plan's network.

Does Medicare cover a nursing home?

Medicare covers a limited stay in a skilled nursing facility after a qualifying hospital stay, but not long-term custodial care in a nursing home.

This article is general information, not insurance advice. Coverage and costs vary, so confirm details with Medicare, your plan or a SHIP counselor.