Does Medicare Pay for Assisted Living or Nursing Homes?
October 28, 2019
Reviewed and Updated by Troy Frink,
Aging can bring up concerns about long-term care for many people, especially if there’s nobody at home to help out. You may wonder about nursing homes or assisted living facilities and how you’ll pay for it when the time comes. If you have Medicare, you may want to know, “Does Medicare pay for assisted living or nursing homes?”
How Much Does Medicare Pay for Assisted Living or Nursing Homes?
Nursing home care can be extremely expensive. According to Genworth, a private room in a nursing home costs an average of $8,517 a month, and assisted living facilities cost an average of $4,051 a month.
Original Medicare –– the public health insurance created in 1965 for retirees –– helps pay for a variety of healthcare costs, but nursing home care itself is not one of them. Custodial care doesn’t fall under Medicare’s guidelines for medical coverage. However, Medicare can help pay for medical expenses during a nursing home stay.
Medicare Part A (hospital insurance) covers up to 100 days at a skilled nursing facility. According to the Medicare Rights Center, “Medicare will not cover the cost of your stay if you need additional days,” or if you need long-term care in an assisted living facility. Part A also covers hospice care. Medicare does not cover room and board at nursing homes or hospice facilities with the exception of short-term stays or respite care.
Original Medicare is divided into two parts: Part A and Part B. Medicare Part A covers inpatient hospital stays. Medicare Part B (medical insurance) helps pay for emergency ambulance transportation. Part B also helps cover doctor appointments.
Original Medicare does not cover prescription drugs. However, you have a couple of different options if you want coverage for prescription medications. You can purchase a Medicare Part D plan, which is only prescription drug coverage, or a Medicare Advantage Prescription Drug (MAPD) plan.
Medicare Advantage plans are private insurance policies that can offer additional benefits to Original Medicare such as meal delivery, non-emergency medical transportation, dental, hearing, and vision coverage.
If you’re at a nursing home for 90 days and have a medical need to stay longer, you may qualify for a Medicare Advantage plan called an Institutionalized Special Needs Plan (ISNP). These plans are designed to cover the specific healthcare needs of someone who requires institutional care including prescription drugs. If you qualify for an ISNP, you may have a Special Enrollment Period (SEP) which allows you to enroll in new coverage or make changes to your insurance plan much more often than those who do not qualify for a SEP.
Click here to read about SEPs and when you can make changes.
What’s the Difference Between a Nursing Home and Assisted Living?
Nursing homes and assisted living centers both provide personal care. The difference is the type of setting. Nursing homes provide medical and personal care in a clinical setting. Assisted living centers offer a more home-like, social setting.
Some people need the clinical setting of a nursing home because of their health condition. For example, someone who cannot walk on his own and requires daily medical care may fair better in a nursing home. Someone who is fully mobile and only requires intermittent medical care and a watchful eye may be better off in an assisted living center.
How Can I Pay for a Nursing Home?
Medicare does not help pay for room & board in nursing homes or assisted living facilities.
Medicare Supplements are private plans that can help pay for Medicare coinsurance or copays, but they only help pay for what you owe Medicare. Since Medicare doesn’t cover nursing home resident fees, Medicare Supplements don’t help with those costs either.
Some Medicare Advantage plans may offer additional coverage for nursing home or assisted living residences. Plans are different in every county and zip code, so we can’t promise that one is available in your area. However, we can get you in touch with a local licensed agent who can give you that information. Call 844-431-1832 or submit your contact information to have someone call you.
Another option to pay for nursing homes or assisted living facilities is life insurance or long-term care insurance. Some whole life insurance policies allow you to draw from them when you need long-term care at a nursing home.
Does Medicaid Cover Nursing Homes?
Medicaid is a state and federal program that helps people with limited incomes receive healthcare. If you qualify for Medicaid and meet your state’s need requirements for nursing home care, your stay may be covered.
Every state has different criteria for determining eligibility for nursing home care. You must also meet your state’s income standard to qualify for Medicaid. According to the Medicare Rights Center, “Your state may have higher Medicaid income guidelines if you need nursing care, or a spend-down program to help you qualify.”
If you qualify for both Medicare and Medicaid, you may also qualify for a Medicare Advantage plan called a Dual Special Needs Plan (DSNP). With a DSNP, you get coverage for all of the Original Medicare program’s benefits, and you also can get some of the supplemental benefits Medicare Advantage plans can provide, such as prescription drugs, dental, and vision. Some plans may even offer additional nursing home coverage. DSNPs often offer low-cost premiums, copays, and coinsurance.
Like an ISNP, a DSNP means you may have a Special Enrollment Period (SEP), however, with this SEP, you can only make one change per quarter from January to September. Any changes you make within those first three quarters will become effective on the first of the month after you make the change.
You can also make a change during the Annual Enrollment Period (AEP), which is from October 15 to December 7, but your new coverage won’t take effect until January 1 of the following year.
What to Look for in a Nursing Home
Entering a nursing home is a big decision. Write down your medical and budgetary needs. For example, you may need a facility that offers memory care. Your nursing home should be capable of handling your medical needs. You should also feel safe and comfortable in your nursing home.
The Centers for Medicare and Medicaid (CMS) has a five-star quality rating system for nursing homes. The rating system is based on health inspection scores, staff-to-resident ratio, and other quality measures. Be sure to check out a nursing home’s rating before you consider moving in. A one-star facility may not provide the quality of care you deserve, but a four or five-star facility might.
Be sure to ask about the nursing home’s costs. Find out how much you’ll pay every month, and if there are any additional items you may have to pay for such as salon services.
If you’re unsure of what to look for in a nursing home, download our nursing home checklist. The list covers items such as questions you should ask and what you should compare when you look at different facilities.
How to Find Medicare-Certified Nursing Homes
Once you’ve determined your budget and medical needs, you can start looking for nursing homes in your area. Use Medicare.gov’s Nursing Home Compare tool to find local Medicare-certified facilities. Click here to get started.
Enter your zip code in the search bar and click “Search.” We used our home office’s zip code of 37209.
The next page you see will be a list of nursing homes in your area. You can sort the list by different criteria. For demonstration purposes, we’re only sorting the facilities by overall rating from highest to lowest. To do this, click on the down arrow under “Overall Rating.”
After you sort the list by your most important criteria, call different facilities to get an idea of price and bed availability. If a nursing home sounds like a good fit, schedule an appointment to tour the facility with your nursing home checklist in hand. You may want to visit the facility more than once before you commit to it.
List of Medicare/Medicaid-Certified Nursing Homes Near Me
We are working on expanding our research for you. We’ve started putting together lists of nursing homes in certain cities. Don’t see your city yet? Send us a message to request a list of nursing homes available in your city.
- Chicago, IL Nursing Homes
- Louisville, KY Nursing Homes
- Knoxville, TN Nursing Homes
- Nashville, TN Nursing Homes
- Memphis, TN Nursing Homes
- Tucson, AZ Nursing Homes
Other Long-Term Care Options
If nursing home care isn’t feasible, you may have other options for long-term care. Talk to your family, healthcare provider, a counselor, or a social worker to see what’s available in your area.
According to Medicare.gov, you may have several options including:
- Home and community-based services
- Accessory Dwelling Units (in-law apartments)
- Subsidized senior housing
- Continuing Care Retirement Communities (CCRCs)
- Group living arrangements
- Hospice and respite care
- *PACE (Program of All-inclusive Care for the Elderly)
*PACE plan availability varies by state. Contact your local Medicaid office for more information.
Find Long-Term Care Coverage
If you need coverage for long-term care, a licensed agent with Medicare Plan Finder may be able to help you find it. Your agent may be able to find long-term care, life insurance, or Medicare Advantage plans that cover nursing home and/or assisted living facilities. To arrange a no-cost, no-obligation appointment, call 844-431-1832 or contact us here today.
