Does Medicare pay for assisted living?

  1. Molly Dworken 10/16/2012 05:33PM

    Medicare is a federal insurance coverage program for seniors 65 and older, providing help to subscribers in paying for many of their medical expenses. But there are limitations to what Medicare covers in various levels of senior care. Some types of long-term care, such as rehab services within a skilled nursing facility, may be covered by Medicare. In most cases, a patient entering rehab care must meet a qualifying stay of three nights, after which Medicare covers a specific number of days at 100 percent, depending on the individual's plan.

    Medicare does not pay for assisted living. Because Medicare's coverage definitions for long-term care are support services, such as help with activities of daily living (ADLs) like bathing, dressing, or using the toilet, and that is typically the level of care provided in assisted living, it does not qualify for coverage. Another of Medicare's guidelines for covered services is that care must be “medically necessary.” The ADL care seniors receive in assisted living facilities is considered “custodial care” and not medically necessary.

    Seniors with traditional Medicare coverage and those with Medicare Advantage Plans or supplemental coverage should direct any questions regarding coverage to the appropriate customer service representative. In most cases, however, alternative financial plans are required to pay for an assisted living facility.