Is Assisted Living Covered by Medicare?
Assisted living communities are residential settings for older adults who are mostly independent, but who need a little help with certain basic tasks. When considering a move to one of these communities, many people wonder if the costs for assisted living are covered by Medicare.
The answer is – it depends.
Medicare coverages can be complex. Medicare covers only certain aspects of healthcare, and Medicaid coverage varies widely by state. The coverage a Florida resident receives can be quite different from the coverage provided to someone in Texas, for example, and that coverage can vary according to the resident’s specific healthcare needs.
While the services that Medicare covers can be confusing, it is in your best interest to have a basic understanding of the coverage before entering into an assisted living community lease.
About Assisted Living
Assisted living is community living that combines housing, personal care services and healthcare. It is intended to help those who need a little assistance with a few basic activities while promoting maximum independence. Assisted living services typically provide help – as needed – with the activities of daily living, such as bathing, eating, dressing and preparing meals. Most people in assisted living communities need help with just one or two activities of daily living, and otherwise lead independent lives.
Assisted living staff members can provide services in freestanding communities, in skilled nursing homes, at independent housing complexes or as part of continuing care retirement communities (CCRCs). Assisted living communities are comfortable residential settings that provide personal care services, 24-hour assistance, activities and health-related services. The services provided at assisted living communities minimize the need to relocate to a family member’s house or to a skilled nursing facility, while accommodating an individual’s changing needs and preferences, maximizing autonomy and safety, and encouraging family and community involvement.
Medicare Does Not Cover Assisted Living, but it May Cover Some Services
Medicare is a national, government-funded health insurance for Americans ages 65 and older. It covers only short-term, non-custodial care in a skilled nursing facility – it does not pay for long-term care such as that provided in an assisted living community or residential care home. However, the program may cover some of the short-term healthcare costs incurred while in an assisted living community.
Medicare coverage of these short-term costs may include:
- 100 percent of the first 20 days in a Medicare-approved skilled nursing facilityfollowing at least three nights in-patient hospitalization
- All but the daily coinsurance for days 21 through 100 in a Medicare-approved skilled nursing facility; residents pay up to $170.50 per day for covered services
- Short-term rehabilitation care at a nursing home following a hospitalization
- Rehabilitation services and in-home therapy, but only in certain cases
Services provided to skilled nursing home residents include:
- Semi-private room
- Meals
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Medications
- Medical supplies and equipment used in the facility
- Ambulance transportation to and from the nearest supplier of medically necessary services unavailable at the skilled nursing facility, but only when taking other transportation would endanger one’s health
- Dietary counseling
Other Medicare Coverages for Seniors?
The Medicare benefit typically covers expenses relating to medical care such as emergency ambulance services, diagnostic testing, kidney dialysis and more. Some Medicare Health Plans (HMOs) include extra medical services such as dental care, drug prescriptions and eye care (vision check-ups).
Other Medicare-covered expenses may include the following:
- Diabetes care
- Emergency care
- Treatment for macular degeneration
- Preventative Services
- Transplants
- Limited medical supplies
Seniors and their caregivers are encouraged to visit the Medicare.gov website to learn more about what services and procedures are covered by the Medicare benefit.
Learn About Medicare Coverage for Assisted Living in Florida
Presidential Place is an assisted living and memory care community in Hollywood, Florida. Our team members can answer questions you may have about Medicare coverage in Florida for assisted living communities. Call us at (954) 894-0059 or complete an online information request, and we look forward to talking with you.