Paying for an Assisted living facility with Medicare?

On Behalf of | Jan 5, 2023 | Medicare and Medicaid |

The perfect candidate for an Assisted Living facility is usually an older adult who needs assistance, and support for activities of daily living, but is still independent. They do not require the full-time skilled nursing offered by skilled nursing facilities. But they may be frail enough that they are fearful of living on their own.

Depending upon the facility the cost to live in one can be roughly $4,500-$6,500. This is a high -ticket item, and people are often dismayed to discover that traditional Medicare does not cover them for these costs.

Medicare only covers certain health care services to Assisted Living residents, but does not cover most assisted living costs.  Here are some of the costs Medicare may cover for an assisted living resident or for someone still living in their home:

  1. Physical therapy
  2. Specific health services like changing sterile dressings
  3. Preventative health services. (For example: Vaccinations)
  4. Health care transportation

The Medicare program is peculiar in that some of its plans may cover some home-care benefits to enable one to live in one’s own home, but not in a designated facility.

These services may include:

  1. Home modifications such as bathroom grab bars and wheel chair ramps.
  2. Some in home assistance with daily tasks.
  3. Transportation to hospital and pharmacy.
  4. Adult day care.

Certain Medicare Advantage plans include services such as those listed above. Coverage

For these services depends upon where you live.  These programs should be reviewed carefully as terms may vary. If you are confused have an attorney read the Medicare Advantage provisions for each plan you are considering.

Medicaid and Assisted Living?

            Medicaid does not cover room and board for assisted living, but it may help pay for personal care services, on-site therapy, and medication management. This could be helpful in the case of facilities where these types of services are “extras” to be paid beyond the monthly fee.

The bottom line is that the assisted living option is a good one with planning and fore knowledge of what you are getting into. An Elder Law Attorney can be helpful with this very important decision.