The federal government’s Medicare benefit program

Does Medicare Pay for Assisted Living?
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By K. K.
The Writers Network
Posted on June 14th, 2011
The federal government’s Medicare benefit program can be quite confusing, especially when you’re trying to plan ahead for long-term care coverage such as assisted living. Many people are under the impression the Medicare covers everything that is needed as they age. However, Medicare specifically covers medical necessities and generally does not cover expenses associated with assisted-living facilities or any other long-term care. Medicare pays for services that are medically necessary, so there may be some instances in which Medicare will pay for services associated with assisted-living arrangements.

Custodial Care

The Medicare program defines most assisted-living facilities as custodial care arrangements, meaning that support services for daily living activities are not medically necessary and are not performed by skilled nursing staff. Custodial care includes such things as bathing, dressing and using the bathroom. Because support services are not medically necessary, Medicare does not cover custodial care.

Skilled Nursing Care

Medicare covers 80 percent of skilled nursing care for up to 100 days after someone has been hospitalized for three consecutive days. These services typically are associated with short-term medical rehabilitation. For example, Medicare will pay for assisted-living facilities for someone who undergoes hip replacement surgery and needs short-term in-patient rehabilitation. Medicare does not cover expenses for permanent or long-term assisted-living facilities, such as nursing home care.

Home Health Care

Medicare covers home health services provided by Medicare-certified providers. The home health services covered by Medicare are extensive, including home health aide support services, part-time skilled nursing care, occupational and physical therapy, speech therapy, 80 percent of durable medical equipment expenses and medical supplies.

Respite Care

Medicare pays for respite care, which is a short-term stay at a hospice facility. Respite care coverage is limited to up to five-day stays; however, there is no limit on the frequency of respite care stays. Medicare covers 95 percent of all respite care services per day. The patient is responsible for no more than $5 for each prescription drug that is administered during respite care.



References:
The Centers for Medicare & Medicaid Services: Long-term Care
National Senior Citizens Law Center: Paying For Assisted Living




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