Medicaid and Medicare Assisted Living Coverage

Rising health care costs, inflation, and other factors mean the cost of residing at an assisted living facility likely increases with time. Learn whether Medicare pays for all or part of the costs of assisted living care. Get answers to questions regarding whether Medicaid covers costs associated with assisted living facility residency.

Does Medicare Cover Assisted Living Care?

Medicare pays for in-patient hospital care under Medicare Part A. Your Part A coverage also pays for lab tests, surgery, and certain other care. Your Part B coverage under Original Medicare pays for doctor visits, visits to other healthcare providers, and other outpatient services. Medicare Part B also covers durable medical equipment and provides coverage for certain preventive services. For example, Part B covers your annual flu vaccine and your pneumococcal (Pneumonia) vaccine. Medicare Part A does not cover the residency costs at an assisted living facility. There are some services typically received at an assisted living facility that is potentially covered by Medicare Part A or Part B. If you or your loved one resides at an assisted living facility, you still have Medicare coverage for the things you normally would if living independently. This includes visits to your doctor, lab tests, certain preventive services, physical therapy or occupational therapy services, and medical supplies. You still pay your normal Medicare co-payments and deductibles. If you are a veteran, your VA benefits do not cover room and board at assisted living facilities. If you have Medicare, you still have the same limited coverage under Original Medicare. Medicare Part A and Medicare Part B do not cover the assistance with activities of daily living (ADLs) that assisted living residents need. An assisted living facility resident typically provides some self-care but needs bathing, dressing, meals or toiletry assistance. You can learn more about Medicare coverage by reading “What Medicare Covers” on the Medicare website.

What Are My Alternative Options To Pay For Assisted Living?

Paying out-of-pocket, using personal resources such as bank accounts or savings for all costs not directly related to care covered under Medicare Part A or Part B is an option for some people. This likely becomes very expensive very quickly for many individuals and families. Taking out a long-term care insurance policy is an option. If you choose a long-term care insurance policy option, read the fine print. Medicare urges you to call the insurance company if you already have long-term care insurance and discuss coverage under your policy. If you are just starting the search for a long-term care policy, consider exclusions such as pre-existing conditions and long-term care exclusions, such as assisted living facility residency and care. Another possible option to cover costs of assisted living facility care is Medicaid.

Does Medicaid Cover Assisted Living Care?

Medicaid, like Medicare, is a health insurance program. Medicaid helps pay some health care costs for individuals with limited income and resources who also meet other eligibility requirements. Medicaid is a joint state and federal program. This means that you have to meet eligibility requirements, including medical necessity, under federal guidelines as well as the requirements in your particular state. States have options regarding whether they pay for some costs associated with assisted living. Medicaid, like Medicare, does not pay the cost of residency, which for many facilities, exceeds $50,000 annually. Another important point is the fact that facilities do not have to accept Medicaid residents, even in states where Medicaid provides some coverage for assisted living facility care. Some states have provided some long-term care at assisted living facilities for eligible residents for years while others only recently began offering Medicaid eligibility for assisted living care. New York began providing assisted living care under Medicaid in 2006. Ohio also implemented its Assisted Living Medicaid Waiver Program in 2006. Mississippi, Nebraska and many other states offer payment for some assisted living-related care. Louisiana, Pennsylvania, and Kentucky are examples of states that provide little to no Medicaid coverage for assisted living.

Where Can I Find Medicaid Assisted Living Near Me?

Once you or your loved one receive verification of Medicaid eligibility and notice that you meet qualifications in your state for assisted living care, start checking online with senior living options under “assisted living.” Other resources include your state Area on Aging department or other programs that help Medicaid recipients with long-term care options, including assisted living. It is important that you check your state Medicaid office to determine whether Medicaid covers any care at local assisted living facilities, and what costs are the responsibility of the resident. Once you start looking at individual assisted living facilities, ask the same questions that you would ask if you paid entirely out-of-pocket. Ask about services, staff to patient ratio, meals and any other questions that come to mind. Some assisted living facilities offer guidance from intake workers, case managers or other staff to help you better understand and navigate the Medicaid process. Always double-check what a worker tells you with your local state Medicaid office. If your state does not offer Medicaid coverage for assisted living or offers very limited coverage, you also still have coverage for the services normally provided under your Part A and Part B Medicare.