As we age, it's normal to need some extra help with everyday tasks like cooking, cleaning, and driving. Luckily, there are plenty of options to receive that extra helping hand. Seniors can turn to assisted living facilities or in-home help with activities of daily living to stay safer, healthier, and as independent as possible.
As you start your search for an assisted living facility, you're probably wondering if your Medicare or Medicaid insurance will help with any of the costs. That's exactly what we'll explore below, along with alternative ways to pay for assisted living.
Does Medicare Cover Assisted Living?
Medicare doesn't cover rent at an assisted living facility (ALF) or help with activities of daily living (ADLs) provided in the facility. But, you can still use Medicare for covered medical expenses at an assisted living facility. It's no different than using Medicare for medical services at a doctor's office or hospital.
You may even be able to use Medicare Part A and Part B for covered home health services while you're living in an assisted living facility.
Covered home health services include1:
- Physical therapy
- Occupational therapy
- Speech therapy
- Medical social services
- Part-time home health aid services
- Occasional skilled nursing care
- Injectable osteoporosis drugs
Only people with Medicare Part A or Part B who are homebound, under the care of a doctor who's overseeing your plan of care, and who need one of the services outlined above are eligible. Visit Medicare's website for more eligibility criteria.
FYI: Annual enrollment for Medicare will be here before you know it! Make sure you're prepared by reading through our Medicare enrollment guide.
Does Medicaid Cover Assisted Living?
Those with Medicaid coverage might have better luck finding financial assistance, depending on where you live. Medicaid coverage for assisted living varies by state because the state and the federal government jointly fund Medicaid. Currently, the majority of the 50 states offer some sort of financial assistance through Medicaid for assisted living services.
Assisted Living Services Covered by Medicaid
Even amongst the states that cover services, what they cover varies. Most commonly, states cover nursing and personal care services either in the senior's home or in an assisted living facility.
Some states enact restrictions, so you'll want to read your state's policies carefully. For example, Ohio only offers a limited number of slots, making coverage competitive. Maine's Medicaid programs provide services to seniors living at home, but not for those who live in assisted living facilities.
Pro Tip: For a closer look at what Medicare and Medicaid cover (and what they don't), visit our guide to Medicare and Medicaid insurance.
Legally, states cannot use Medicaid funds to cover assisted living room and board; you'll need to use other funds to pay for your housing and your food at an assisted living facility.
Some states use non-Medicaid programs to help older adults with these costs. For example, in Rhode Island, seniors can receive up to $1,500 to put toward any assisted living costs through the state's SSI Enhanced Assisted Living program.
States with Little to No Medicaid Assisted Living Coverage
The following states offer minimal or no Medicaid coverage for assisted living or assisted living services:
- New York
If you live in one of the above states, check the state's website to see if they offer other financial assistance programs.
How Do I Find Assisted Living That Accepts Medicaid Near Me?
Even if you live in a state where Medicaid covers assisted living, an assisted living facility can decide not to take Medicaid.
Here are a few ways you can find covered assisted living facilities:
1. Call Assisted Living Facilities Directly
Do you already have an assisted living community in mind? Give them a call to see if they accept Medicaid. If they don't, you may want to look elsewhere. Assisted living can be expensive, so finding a location that takes Medicaid insurance is a priority for many seniors. On the other hand, if you have other means of paying for assisted living (more on that later), this won't be a major concern.
2. Visit Your State's Medicaid Website
Log into your online Medicaid portal or visit your state's Medicaid website. From there, you can speak with a customer service representative to ask about local services. You might also be able to search on the website for a list of providers that accept Medicaid.
3. Use Our Find Senior Housing Tool
Our senior housing tool makes it easy to find nearby assisted living facilities. Just input your ZIP code, and we'll filter out the results by payment method, so you'll get a list of nearby ALFs that accept Medicaid. You can then learn about the different facilities, compare their features and costs, and set up some phone calls or visits if one catches your eye. Talk about simple!
How Can I Pay for Assisted Living?
No luck with Medicaid? There are other ways to pay for an assisted living facility or in-home services you need. Before deciding how to pay, carefully review your personal finances, find out if your family can help, and weigh the pros and cons. To help, we'll briefly touch on some popular ways that older adults and their loved ones pay for care.
Long-Term Care Insurance
Long-term care (LTC) insurance is a policy that covers expenses like staying in a nursing home, home health care, or even assisted living. What's tricky with long-term care insurance is that you need to purchase it before you need it. If you already have a disability or need help with ADLs, it's likely too late to buy a policy.
What We Like About Long-Term Care Insurance
- Helps lower your out-of-pocket cost for care
- More choices for care
- Protects your savings and your family's resources
- Cheaper when you buy it earlier
- Different coverage levels available
Things to Keep in Mind About Long-Term Care Insurance
- Not accepted everywhere
- Premiums often increase over time
- Harder to qualify for a policy as you get older
- Some plans won't kick in until you pay out-of-pocket for a set amount of time
Before deciding to purchase a LTC insurance policy, do your research. Check what services are covered. For example, many policies only cover assisted living care if you live in a facility; they don't cover in-home assisted living services. If navigating insurance isn't your thing, ask your trusted loved ones for help.
Pay Out of Pocket
Seniors or their families often pay for assisted living costs out of pocket, especially for home-based care. That doesn't mean you have to drain your savings, though. Families often use a mix of personal savings, retirement accounts, annuities, Social Security payments, and pensions. Some older adults sell their homes and use the profits to move into an assisted living facility.
What We Like About Pay Out of Pocket
- No insurance premiums
- Able to choose any facility you like
Things to Keep in Mind About Pay Out of Pocket
- Ties up your money
- Might be hard to find a facility you can afford
- Could run out of money
Before choosing to pay out-of-pocket, check with your state to see if you're eligible for Medicaid and if that would help with coverage. You should also carefully review your finances, talk to your family, and create a budget. You'll want to choose service providers that you can afford long-term if you think you'll need ongoing care.
Are you a veteran or married to a veteran? If so, call the Department of Veterans Affairs (VA) or visit a nearby VA medical center to learn about senior living options for veterans. The VA won't cover room and board at an assisted living facility, but they might pay for extra services like nurse visits2.
What We Like About Veteran's Benefits
- Could cover extra care from a health professional
- Could cover other extra services offered at an ALF
Things to Keep in Mind About Veteran's Benefits
- Some veterans still need to pay a copay
- Doesn't cover room and board