Medicare doesn’t cover the cost of personal care or room and board at an assisted living facility, however, it may be used to cover certain medical expenses a person incurs while they reside in such a facility. Seniors who are on a low income and would struggle to pay for assisted living may be eligible for state Medicaid programs that cover all or part of the associated costs.
Assisted living is a lifeline for many seniors who are unable to tend to their own personal care needs but don’t require the full-time care and supervision provided in nursing facilities. The average cost of assisted living in the United States is $4,300 per month. This is almost three times the average monthly Social Security retirement benefit amount, which means many seniors need assistance from Medicare, Medicaid or other programs to cover the cost.
Original Medicare doesn’t cover the cost of long-term care, but it may cover some medical expenses a senior incurs while residing in an assisted living facility. Medicare may cover the cost of a short stay in a skilled nursing facility, but only to support a senior’s recovery after an inpatient hospital stay.
Medicare Part C (also known as Medicare Advantage) plans may offer some coverage for assisted living care. Any coverage offered is at the insurance company’s discretion, and most insurers require proof that such care is medically necessary.
Low-income seniors may be eligible for Medicaid, a program that offers additional support for those who can’t afford the cost of Medicare deductibles and premiums. Medicaid covers more long-term care services than Medicare, but the scope of coverage is determined at the state rather than the federal level.
Many states offer Home and Community-Based Services (HCBS) waivers to provide assistance with personal care, housekeeping and other assisted living services. Most HCBS waivers don’t directly cover room and board, but Medicaid-eligible seniors may be able to qualify for other state-funded programs that help with these costs. Local agencies, such as Area Agencies on Aging, often provide free long-term care options counseling to help seniors and their families find ways to pay for assisted living.