Does Medicare pay for assisted living care?

8 answers | Last updated: Mar 24, 2017
A fellow caregiver asked...

My mother has Alzheimer's and is 88 years old. She is in a rehab center after a fall. She was in ICU for a week and was extremely dehydrated and not eatting when all this happened. Since she is not able to care for herself at all anymore and Dad is not able to care for her either, does Medicare pay for assisted living care?

Expert Answers

No, Medicare doesn't pay at all for assisted living. Medicare coverage for long-term care of any sort is very limited, covering only short-term stays in a skilled nursing or rehabilitation facility while someone recovers from an illness, injury, or surgery. Medicare doesn't pay at all for what's called "custodial" -- meaning non-medical -- residential care in a nursing home or assisted living facility.

In some states, though, Medicaid can pay for assisted living in certain participating facilities. If the state Medicaid program where your parents live does cover some assisted living, you would have to find an assisted living facility that participates in Medicaid. But all this depends on whether your mother would qualify for Medicaid, which she can do only if your parents have low income and assets (other than their home). To see about the Medicaid eligibility rules for assisted living in the state where they live, you can go to the Medicaid information page at the federal government's Govbenefits web page.

Community Answers

Campines answered...

I heard that medicare covers inpatient respite care for up to 5days with a terminal illness which is certainly alzheimers. Is this true??What a help this would be for us caregivers. Thanks

Frena answered...

actually, it is NOT true that Medicare never pays for assisted living.

i had a small assisted living in arizona up to two years ago and i can assure you that in arizona -- and i believe in a number of other states also -- care home owners and big facilities could make contracts of agreement to accept Medicare residents for longterm care. In my five-bed home, i had three folks paid for by Medicare -- which is activated via the Arizona state Medicare partner, ALTEX. two of my folks stayed with me for 2 years and that other for three and a half years.

the drawback is that not all places will make such a contract -- Medicare pays at least a thousand a month less than private pay, which is a big loss in income for a small home. But there we are. they were great people and i loved them.

so, you should check more fully with your own state to find out if they do partner with Medicare to cover longterm care, because they might well do so.

Also, these days increasing numbers of states are beginning to put into action a payment to family caregivers, to help them stay home to care for a family member. sometimes that can make all the difference in keeping someone home. It's usually at least $1,000 monthly. Again, check with your state health system. Start with your local senior center and/or local Area Agency on Aging -- they have all the data.

Good luck!

Gabrielheiser answered...

Arizona Long Term Care System (ALTCS) is actually a Medicaid--not Medicare--program, so I think the prior post was incorrect in stating that Medicare covered long-term care.

A fellow caregiver answered...

I am a hospice Social Worker in Texas. Medicare, which is a federal program does not pay for long term care in a nursing facility, assisted living facility or a Personal Care Home ( someone who cares for others in their private homes). The guidelines for Medicaid differ state to state. As stated previously, you have to be income eligible to qualify for Medicaid. In Texas, if you qualify for Medicaid it will pay for long term care in a nursing home or pay for a provider to come into your home (number of weekly hours you receive for a provider is determined by a state caseworker). Hope this helps.

Irish4girl answered...

I can promise you that here in Alabama, Medicare pays for NOTHING when it comes to Assisted Living. In fact, with my Mom, who is in the final stages of Alzheimer's, it has been an act of God for Medicaid to help us. While Mom was in the Assisted Living since 2005, my family has gone through every cent of savings, 401k, and paychecks trying to meet the bill every month.
The bottom line is the law needs to change. The people with Alzheimer's, as well as their families need some sort of re-course. As for Medicaid, every time we turn in the paper work (4 times now), if they even acknowledge they have received the paperwork, they have sent us back a letter saying they need something else. It has gotten so bad, that we are now hand delivering all paperwork and keeping copies of everything. Why they don't have a list of everything you are going to need posted, is a major concern. I think my Mom will pass away before Medicaid gets around to approving her case. What's more difficult is the Nursing Home side of facilty cost us $5000 / month where as the Assisted Living was $3200 / month. Since we haven't won the lottery, this increase hurts tremendously. Mom has to have the 24 hour care, there is no choice but to pay it.

Nuphilagal answered...

Case managers can help with medicaid approval. Not case worker but a case manager assigned to help with needs like driving to doctor appointments, filling out paperwork dealing with medicaide case workers.

A fellow caregiver answered...

they have a new consumer choice options program thats works with dhs called consumer choice of 2016