Medicaid & Medicare Assisted Living Coverage

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.

Does Medicaid Cover Assisted Living?

Seniors 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 assisting 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.

Legally, states cannot use Medicaid funds to cover assisted living room and board. That means 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 seniors 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:

Alabama
Louisiana
Pennsylvania
Virginia
Kentucky
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 ALF in mind? Give them a call to see if they accept Medicaid. If they don't, you may want to look elsewhere. Assisted living is 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 that you can pay for the assisted living facility you like or the 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 seniors 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 offered. 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, have a trusted loved one help you.

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 seniors 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.

Veteran's Benefits

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 services2 like nurse visits.

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

Medicaid and Medicare Assisted Living Coverage