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generally doesn’t cover the cost of residing in assisted living communities, which are facilities that offer housing and custodial services — such as laundry, cooking and managing medications — for older adults. However, it does cover care received at skilled nursing facilities, which are equipped to provide more medical care than assisted living communities, when certain requirements are met.
If you move to an assisted living community, Medicare will still cover your approved prescriptions, surgeries, doctor’s appointments, screenings and medical equipment, just as it did when you lived at home.
Assisted living communities, which are in residential settings, aren't the same as nursing homes or skilled nursing facilities, which are in clinical settings.
Nursing homes offer a greater level of medical care and may be eligible for Medicare coverage in certain cases. Assisted living communities generally focus on providing custodial care, such as bathing, eating, meal preparation, getting dressed or using the bathroom. Original Medicare ( and ) doesn’t include coverage for custodial care when it's the only care you need.
In some cases, a company might operate both an assisted living community and skilled nursing facility in the same building or a neighboring one, under the same name. The coverage you receive through Medicare depends on which care you're receiving and whether you meet certain requirements.
In order to get Medicare coverage for skilled nursing care:
If you meet all these conditions, you would be 100% covered for the first 20 days in residential care, then be responsible for $185.50 per day in coinsurance for days 21 through 100. After 100 days Medicare doesn’t provide any coverage for this type of care.
(Medicare Part C) must cover at least as much as Original Medicare. But since Medicare Advantage is private insurance contracted through the government, the specific benefits of each policy are unique.
That said, Medicare Advantage doesn’t typically cover assisted living or any other long-term custodial care, although it continues to cover your eligible medical expenses like prescriptions, surgery, doctor’s appointments, screenings and equipment if you move to an assisted living facility. It may also provide some additional benefits such as transportation to your medical appointments, vision and hearing coverage and gym memberships.
Also like Original Medicare, your costs may be covered if you need short-term care at a skilled nursing facility immediately following a hospitalization.
Get more information below about some of the major Medicare Advantage providers:
The national median cost for residential care at an assisted living facility was $51,600 per year in 2020, according to a survey from Genworth, a major provider of long-term care insurance.
In general, if you have your policy will usually cover these costs if you meet certain requirements. If you don't have this type of coverage, you may have to tap into savings or home equity to cover costs.
Moving to an assisted living community is a huge step, both financially and emotionally. If you’re unsure about whether this is an appropriate option, here are a few clear signs that assisted living might be right for you:
Assisted living communities also may have minimum age requirements; for example, some are limited to residents 62 and older.
Before choosing an assisted living community, be sure to confirm that it's properly licensed and reputable. Many state websites have online tools that allow you to look up assisted living communities in your area, check licenses and read inspection or investigation reports.