Medicare and Assisted Living: What's Covered?

Medicare does not generally pay for long-term care in assisted living facilities. However, the program does temporarily cover costs associated with skilled care in a nursing home or rehabilitation center after a qualifying hospital stay of at least three days.

Cost

• During the first 20 days of qualifying skilled care coverage or rehabilitation, Medicare pays the entire amount. After 20 days, the resident is responsible for up to $128 per day for a maximum of 100 days. After 100 days of continuous care, the resident is responsible for the full cost. These maximums are per benefit period.

Considerations

• According to Medicare guidelines, a new skilled nursing benefit period begins after a patient has a "break" of at least 60 days from skilled care. However, to be eligible for assisted living during the new benefit period, the patient still needs a minimum three-day hospital stay.

Alternate Payment Options

• Individuals in assisted living may consider private long-term insurance for a monthly premium. Alternatively, the federal- and state-funded Medicaid program may help pay for assisted living costs. Medicaid eligibility depends on income and disability factors.