How much does Medicare pay for assisted living?

Cost is a significant factor in considering senior care. How much does assisted living cost? Does Medicare cover any retirement living costs? To understand what (if any) senior care may be covered by Medicare, it’s important to thoroughly know what Medicare covers and how it can be applied. 

Medicare is a federal health insurance program for U.S. residents over the age of 65. There are four parts to Medicare — Part A, B, C & D. Medicare is also known as Title XVIII of the Social Security Act.

Medicare Part A (hospital insurance) pays for inpatient hospital care, some skilled nursing, hospice, and home health care (if prescribed). Part A is premium-free for 99% of beneficiaries due to paying Medicare taxes while employed.

Medicare Part B (medical insurance) covers outpatient physician and hospital services, some home health services, and durable medical equipment.

Medicare Part C (Medicare Advantage plan) allows private companies like HMOs and PPOs to offer health insurance that provides at least the same benefits of Parts A & B, but usually additional benefits, such as dental and vision.

Medicare Part D offers prescription drug benefits through private insurance companies at the cost of additional monthly premiums.

It can be surprising to learn that Medicare traditionally does not cover assisted living costs. While it will pay for most medical costs incurred while a senior is in assisted living, it does not cover any costs of personal care or room and board costs. In some cases, Medicare Advantage plans may pay for personal care assistance, but they will not cover room and board costs.

Although Medicare doesn’t cover assisted living costs, it can cover costs in a skilled living facility when certain requirements are met. Skilled nursing facilities are equipped to provide more medical care than what is offered at an assisted living facility. 

To get Medicare to cover skilled nursing costs:

- The beneficiary must have had a recent hospital stay and not used up all of their hospital days.

- A doctor has ordered this care.

- The senior’s current condition is they were just hospitalized, or it developed while in the hospital (such as an infection).

- The skilled nursing care is considered necessary.

If all conditions are met, Medicare will cover the costs of skilled nursing care for the first 20 days. After that, the patient will be partially responsible for days 21-100. And Medicare doesn’t provide any coverage after 100 days.

What does Medicare cover for senior living?

If a senior transitions to an assisted living facility, Medicare will continue to cover the cost of their prescriptions, doctor’s appointments, surgeries, screenings, and medical equipment, just as it did while they were living at home. 

The costs for assisted living and other types of senior care can vary widely from each facility. Senior Care Finder is here to help you find the best options for senior care. Search here to find assisted living options near you.

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