Sometimes living alone is no longer safe or practical, but a nursing home feels like too much hands-on care. In these cases, assisted living might be a sensible solution. The staff of these facilities offer help with daily tasks while still supporting as much independence as possible in a safe environment. Medicare may cover certain medical services provided in these communities, but it does not cover living costs.
[Read: Low-Income Assisted Living Options]
What Is Assisted Living?
Assisted living communities, as mentioned above, provide support for individuals who don’t need medical care but who do need assistance with activities of daily living, such as bathing, dressing, grooming and toileting. This type of care is known as “custodial care.”
These facilities also provide services such as:
— Continuous 24-hour on-site staffing to handle health emergencies
— Care coordination, such as scheduling doctors’ appointments
— Dining options and meal service
— Medication management
— Social activities
— Transportation to and from activities and tasks, such as visits to the doctor 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: A Checklist For Finding the Best Assisted Living Facility]
How Much Does Assisted Living Cost?
According to Genworth and CareScout’s 2024 Cost of Care Survey, the median monthly cost for assisted living is $5,900, or $70,800 annually. However, these costs can vary significantly based on a number of factors, the most important being where you live.
Does Medicare Cover Assisted Living?
No, Medicare — the federal health insurance program primarily for those over age 65 — does not pay for long-term care, including custodial care. Typically, these are the services that assisted living residents most need.
“Medicare does not provide any reimbursement to assisted living communities despite the fact that the vast majority of residents in assisted living communities are Medicare recipients,” Williams adds.
Does Medicare Cover Assisted Living for People With Dementia?
Medicare does not cover assisted living costs, including room and board and custodial care, for those living with dementia. Rather, families generally have to pay out-of-pocket for loved ones with dementia who require regular care at an assisted living facility.
Generally, Medicare also won’t pay for stand-alone memory care facilities or those at continuing care retirement communities, which may have memory care as part of their graduated care options. However, Medicare may pay for medically necessary services (like those below) for memory care residents.
[READ: How Much Does Memory Care Cost?]
What Health Care Services Does Medicare Pay For?
Although original Medicare (Part A and Part B) does not cover the cost of assisted living, it does cover certain medically necessary services even if they’re provided in an assisted living facility, including:
— Doctor and specialist visits. Many assisted living facilities contract with physicians or nurse practitioners who visit regularly.
— Diagnostic lab work. Blood draws can often be done on-site by mobile lab services.
— Durable medical equipment. Many times, durable medical equipment, such as wheelchairs, oxygen and walkers, can be delivered and maintained on-site.
— Home health services. Physical, occupational and speech therapy, as well as other health services, can often be arranged if determined medically necessary.
— Preventive care. Certain services, such as vaccinations, blood pressure checks and health screenings, can be done on-site.
— Skilled nursing care. Short visits by Medicare-certified home health nurses may occur if specific criteria are met.
— Telehealth visits. Facilities often provide technology or assistance for virtual appointments.
Other Ways to Pay for Assisted Living
Alternative ways to pay for assisted living include:
— 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, a joint federal and state health insurance program, helps low-income individuals who meet specific financial and medical need criteria. Medicaid residents represent approximately 15% to 17% of all residents in assisted living and similar communities, says Williams. For those 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. Meet with an elder law attorney to discuss these options in more detail.
— 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.
— Veterans 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.
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Does Medicare Pay for Assisted Living? originally appeared on usnews.com
Update 06/25/25: This story was previously published at an earlier date and has been updated with new information.
