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Does Medicare Pay for Assisted Living?

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There comes a time when everyday tasks like bathing and dressing can become challenging.

If living independently is no longer an option, but a nursing home feels too intensive, assisted living provides a balanced solution. It focuses on preserving as much independence as possible while offering support and assistance to individuals in a safe environment.

While Medicare may help cover specific health care services within these types of facilities, it does not pay for assisted living.

What Is Assisted Living?

Assisted living communities provide support for individuals who don’t need nursing home care but need help with activities of daily living (ADLs) — such as bathing, dressing, grooming and toileting — while maintaining their independence.

These facilities provide services, such as:

— Assistance with personal hygiene, such as bathing or dressing

— Continuous 24-hour on-site staffing to handle health emergencies

— Life management, such as scheduling doctor’s appointments

— Meal service

Medication management

— Transportation to and from activities and tasks, such as doctor appointments or shopping

Assisted living promotes independence, purpose and dignity for the more than 1.4 million American seniors who live in one of the more than 31,000 assisted living communities across the country,” says Paul Williams, vice president of government relations for Argentum, an assisted living trade organization in Washington, D.C.

[READ: 7 Signs It’s Time to Move to a Senior Living Facility]

Does Medicare Cover Assisted Living?

No, Medicare does not cover the cost of assisted living.

Medicare does not pay for custodial care — which involves assistance with bathing, dressing, grooming, toileting and other ADLs — if that is the only type of care you need. Typically, custodial care is the primary need for most assisted living residents.

[READ: Nursing Homes vs. Assisted Living.]

What Health Care Services Does Medicare Pay For?

While it doesn’t pay for assisted living itself, Medicare Part A (hospital insurance) may cover some health care services for individuals in assisted living, including:

Home health services. Medicare may pay for some home health services, such as physical therapy or wound care.

Medical services. Doctor visits and certain medical supplies may be covered.

Prescription drugs. Medicare Part D or Advantage plans with drug benefits may cover prescription medication while living in an assisted living facility.

[Read: How to Know Your Loved One Is Getting the Senior Care They’re Paying For]

Other Ways to Pay for Assisted Living

Assisted living can range in price from $5,350 monthly or $64,200 annually, according to Genworth Financial’s 2023 Cost of Care Survey. Costs vary depending on how long you reside in the community, what services and amenities you use and where your community is located.

While Medicare doesn’t cover the bill for assisted living, there are other ways to pay for assisted living, including:

Medicare Advantage. While some Medicare Advantage plans may provide limited coverage for custodial care, these benefits vary significantly between plans. Check with your plan to see what benefits you are entitled to.

Long-term care insurance. Long-term care insurance policies can help pay for assisted living. Policies must often be purchased years in advance, and benefits depend on the terms of the policy. A medical assessment may be required to activate the policy.

Medicaid. Medicaid helps low-income individuals who meet specific financial and medical need criteria. For those who are ineligible because of their income, a spend down–where you reduce your finances to meet the program’s eligibility requirements–may make it possible to qualify.

Self-pay. Many families use personal savings, retirement accounts, proceeds from selling a house or investments to cover the costs. Approximately 80% of assisted living care and services are paid for privately by the resident and their family according to Williams.

Veteran’s benefits. Veterans and their spouses may qualify for this benefit to help cover long-term care costs, including assisted living. This requires meeting certain benchmarks and having a qualifying military service history.

Bottom Line

Assisted living is for those who desire a greater level of independence while receiving support with daily living activities that have become challenging. Original Medicare does not cover the cost of assisted living facilities. It does not cover help with activities of daily living — such as bathing, dressing or other activities, which are typically the primary needs of assisted living residents.

Some Medicare Advantage plans may offer limited benefits for assisted living facilities, though these vary widely depending on the specific plan. Medicare may cover certain medical services for residents of assisted living facilities, such as doctor visits, physical therapy and prescription medications. While Medicare does not cover assisted living, individuals can explore other options like Medicaid, long-term care insurance, self-pay or veterans benefits to help offset costs.

More from U.S. News

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What Is the Medicare Prescription Payment Plan?

How Medicare Part D Has Changed for 2025

Does Medicare Pay for Assisted Living? originally appeared on usnews.com

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