Does Medicare Cover Assisted Living?
Medicare doesn't cover the cost for you to stay in an assisted living facility.
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That's because Medicare doesn't consider help with everyday tasks, like dressing, bathing and cleaning, to be medically necessary. You might be able to get coverage for assisted living from Medicaid, the Department of Veterans Affairs (VA) or a long-term care insurance policy.
Does Medicare pay for assisted living?
Medicare doesn't pay for assisted living, but it can pay for similar care in some situations.
Assisted living provides what's called "custodial care," which is non-medical help with daily living tasks. Medicare doesn't consider these services to be medically necessary, so it doesn't cover them. However, Medicare does cover skilled nursing care, which includes things like taking care of wounds and physical therapy.
Custodial care helps with:
- Bathing
- Dressing
- Cooking
- Eating
Skilled nursing care includes:
- Physical therapy
- Wound care
- Injections
- Help with catheters
Assisted living facilities vs skilled nursing facilities
Assisted living programs let seniors maintain a semi-independent lifestyle while helping them with things like getting dressed and showering or bathing.
Skilled nursing facilities focus on providing medical care. You might go to a skilled nursing facility after suffering a bad accident or if you're recovering from a serious disease.
How much does assisted living cost?
Assisted living costs a median amount of $5,900 per month.
That's over $70,000 per year. The cost of assisted living varies by state. South Dakota has the cheapest median cost for assisted living at $4,350 per month, while Hawaii has the highest cost at $11,311 per month.
There are over 800,000 people in assisted living in the U.S., and most of them are women. The median stay is 22 months, which means a cost of nearly $130,000.
Assisted living costs by state
State |
Median monthly cost
|
|---|---|
| Alabama | $4,572 |
| Alaska | $10,198 |
| Arizona | $6,370 |
| Arkansas | $4,724 |
| California | $7,350 |
Source: Genworth Financial and CareScout's 2024 Cost of Care Survey.
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How to pay for assisted living
Although Medicare won't pay for assisted living, other programs might cover some of the cost. Medicaid and Veterans Affairs (VA) coverage can help, if you qualify. Long-term care insurance is the most complete option, but it can be expensive and not many companies offer it.
See if you can get on Medicaid
Medicaid usually pays for some, but not all, of the costs for assisted living. Keep in mind that Medicaid coverage changes in each state, and some states have better coverage than others. About 1 in 5 assisted living residents uses Medicaid to help cover the cost.
For example, Medi-Cal, California's Medicaid program, will pay for you to stay in an assisted living facility if you qualify for its assisted living waiver program. Other states may not offer this level of coverage.
The best way to find out if Medicaid covers assisted living in your state is to contact your local Medicaid office. You can find your office's contact info on Medigaid.gov, using the "Contact Your State Medicaid Agency" tool.
But it's not likely that Medicaid will cover the entire cost for assisted living. Also, each state's Medicaid coverage is slightly different. Contact your local Medicaid agency to find out more about your state's coverage.
Use your Veterans Affairs (VA) coverage, if you have it
VA health care pays for certain types of long-term care, like assisted living facilities, nursing homes, home health aides and caregiver support. You must already be signed up for VA health care, and you need a doctor's approval before accessing VA assistance for any type of long-term care help.
Consider buying long-term care insurance
Long-term care insurance covers you when you stay in an assisted living facility, retirement home or adult daycare. It also often provides reimbursement for in-home care.
Most long-term care insurance policies pay up to a certain dollar amount per day up to a total amount. Some policies don't have a daily limit, though, and instead just have a cap on how much they'll pay out in total.
You usually have to get long-term care insurance as a rider on a life insurance policy. However, a few companies still sell traditional long-term care insurance policies.
It's a good idea to buy a long-term care insurance policy when you're younger rather than waiting until you need the coverage. The cost for long-term care insurance goes up as you age. The high cost often means people can't afford to buy a policy, and you may not even be eligible depending on your age.
Move into subsidized housing
Subsidized housing, also called Section 202 housing, is designed for seniors with low incomes who need support with things like cooking and cleaning. It's not truly assisted living, but it could be a good option for some people.
To qualify for Section 202 housing, you have to be at least 62. You also can't make more than half of the median income in your area.
To find subsidized housing in your area, you can use a map tool available from the Department of Housing and Urban Development (HUD).
Medicare alternatives to assisted living coverage
While Medicare doesn't pay for assisted living facility costs, it does pay for several similar services.
- Home-based care: Medicare will pay for a nurse or another health care professional to visit you at your home for no more than eight hours per day up to 28 hours per week if you need medical care. However, this help won't include things like grooming, dressing or cleaning.
- Skilled nursing facility: A skilled nursing facility offers medical care, therapy and meals for people recovering or managing health issues. A doctor has to confirm that you need skilled medical care before your coverage will start. Medicare pays for all of your costs for the first 20 days and part of your costs for the next 80 days. Coverage ends after 100 days within a single benefits period.
- PACE: The Program of All-Inclusive Care for the Elderly (PACE) is a government program that helps people 55 and older pay for their health care needs. Although it won't pay for assisted living care, it will pay for some medical costs including adult day care, nursing home care and meals.
- Hospice care: Medicare may cover all of your hospice care if you're diagnosed with a terminal illness.
Certain parts of Medicare may also pay for some costs you might run into when you're in assisted living, although they won't pay for the cost of being in an assisted living facility.
- Medicare Supplement plans: Medicare Supplement plans, also called Medigap plans, give you extra coverage above and beyond Original Medicare. Medigap plans can pay for some care if you're at an assisted living facility by making it cheaper when you go to the doctor or hospital.
- Medicare Advantage (Part C) plans: Medicare Advantage (Part C) bundle your Part A and B coverages together and usually include extra coverage, like vision, dental and hearing care. These plans can help you get coverage for additional medical care.
- Medicare Part D plans: Part D coverage can pay for your prescriptions while you're staying in assisted living, but it won't pay for anything else.
Frequently asked questions
How much will Medicare pay for assisted living?
Medicare will not pay anything for assisted living because it isn't considered medical care. However, Medicare will cover skilled nursing care, which is medically necessary in some cases.
Why does Medicare not cover assisted living?
Medicare doesn't consider assisted living to be medically necessary. Assisted living is a type of arrangement where people live mostly independent lives but get help with daily living tasks like eating, cooking, cleaning and bathing. Because these aren't medical tasks, Medicare doesn't pay for them
How can I pay for assisted living?
If you can get on Medicaid or if you have Veterans Affairs (VA) coverage, you might have coverage for assisted living. Buying a long-term care insurance policy is also an option, but they can be expensive. You'll get a better rate if you buy a policy when you're younger.
Sources
The average cost of assisted living is from the 2024 Cost of Care Survey from Genworth Financial and CareScout.
Other sources for this article include the the American Health Care Association and the National Center for Assisted Living (AHCANCAL), the Centers for Medicare & Medicaid Services (CMS), the California Department of Health Care Services (DHCS), the Department of Housing and Urban Development (HUD), the Department of Veterans Affairs (VA), Medicare.gov, and the National Low Income Housing Coalition.
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