Does Medicare Pay for Assisted Living?

What Seniors and Families Need to Know About Costs, Coverage, and Alternatives

When families begin exploring senior living options, one of the most common and urgent questions is:
👉 "Will Medicare pay for assisted living?"

The short answer is no but the full story is a bit more complex. In this blog post, we’ll break down what Medicare does (and doesn’t) cover, the average cost of assisted living, and what financial support options are available if you or your loved one needs long-term care.

Does Medicare Cover Assisted Living?

Medicare is a federal health insurance program for people aged 65+ and some younger individuals with disabilities. While it covers medical care, it does not pay for custodial care, meaning, it doesn’t cover assisted living, memory care, or long-term stays in residential care homes.

Why not?

Because assisted living is considered non-medical care, primarily offering help with “activities of daily living” (ADLs), such as:

• Bathing

• Dressing

• Meal preparation

• Medication reminders

• Transportation

If a resident needs temporary medical care, such as a hospital stay or outpatient services, Medicare will still cover those specific medical treatments but not the cost of living at the assisted living facility itself.

What Does Assisted Living Cost?

According to Genworth’s most recent national study, the median monthly cost for assisted living is $4,500, or roughly $54,000 per year. Prices can vary based on:

• Location (urban vs rural)

• Level of care needed

• Type of residence (studio, private apartment, shared room)

• Extra services or memory care

In comparison, a private room in a nursing home can exceed $9,000/month so assisted living is often a more affordable long-term solution.

What About Short-Term Nursing Facility Stays?

Medicare will pay for short-term care in a Medicare-certified skilled nursing facility (SNF), but only under these strict conditions:

✅ You had a qualifying 3-night inpatient hospital stay
✅ You enter the SNF within 30 days of leaving the hospital
✅ A doctor certifies that you need daily skilled care

Here’s how Medicare covers it (2024 rates):

• Days 1–20: $0

• Days 21–100: $204 per day

• After 100 days: You pay 100% out-of-pocket

Medicare Supplement (Medigap) plans may help cover those daily copays—but again, this does not include long-term assisted living or memory care.

Financial Help for Assisted Living

Even though Medicare won’t help pay for assisted living, you still have options. Here are the most common funding alternatives:

1. Long-Term Care Insurance

If you have a policy, it may cover a portion (or all) of your assisted living costs once you meet certain criteria—typically the inability to perform two ADLs or having cognitive impairment. Policies vary, so review the fine print.

2. Medicaid Waiver Programs

Medicaid doesn’t typically cover assisted living nationwide, but some states offer waivers that do. Qualification depends on income, assets, and medical need. Waiting lists and enrollment caps may apply, so start the process early.

3. VA Aid & Attendance Benefits

Veterans and their surviving spouses may qualify for monthly financial assistance through the VA Aid & Attendance benefit. This can help offset the cost of assisted living or in-home care.

4. State and Local Programs

Your local Area Agency on Aging may offer grants, vouchers, or sliding scale programs to assist with housing and care costs. Don't hesitate to reach out and ask what’s available in your county or region.

5. Home Equity Tools

In some situations, reverse mortgages or converting a life insurance policy into cash can free up funds for care. These options should be approached with legal or financial guidance to avoid unintended tax or ownership consequences.

What About Medicare Advantage Plans?

Some people assume their Medicare Advantage (Part C) plan will pick up the slack but this is a common misconception. These plans may offer extra benefits like transportation, meal delivery, or even adult day care, but they rarely pay for assisted living housing or long-term support services.

Always review the plan's Evidence of Coverage document to understand what’s included and what’s not.

Final Thoughts from ARD Strategies for Seniors

Medicare plays an essential role in covering medical needs, but when it comes to long-term housing and personal care, it leaves a gap. Families must plan ahead and understand all available resources everything from long-term care insurance to VA benefits to local assistance.

At ARD Strategies for Seniors, we guide families step-by-step through the senior placement process. Whether you're just starting to explore options or you're in an urgent situation, our compassionate team can help you find the right solution, affordably and efficiently.

📞 Call us today at 480-331-3604 or 602-550-7365 to schedule a free consultation.