Does Medicare pay for assisted living?

Unfortunately, no. Except for a few rare cases, Medicare does not cover room and board and many other costs of assisted living facilities or any other long-term care. State Medicaid may offer some assistance, but it is often difficult to qualify for it. To cover daily long-term care needs, you’ll likely need another solution, like long-term care insurance from New York Life Insurance Company or New York Life Insurance and Annuity Corporation.

Does Medicare pay for assisted living or long-term care?

Medicare is a government health insurance program for U.S. residents 65 or older and some younger people with disabilities. It’s broken into a few different parts, and it's designed primarily to cover inpatient hospital care, doctors’ visits, and prescription drugs.

Most assisted living facilities and nursing homes offer long-term (or custodial) care. They provide help with activities of daily living (ADLs), like bathing, eating, using the bathroom, and moving around. Medicare does not cover these services, except in a few narrow cases.  

Why doesn’t Medicare cover long-term care?

Medicare is designed to cover healthcare costs for elderly Americans. If you have health services provided to you at a nursing home or an assisted living facility, they will likely be covered. But standard room and board and help with everyday tasks, which is the bulk of the cost of an assisted living facility or nursing home, is not covered. Private health insurance usually does not cover these costs, either. To protect yourself and your family, should you need long-term care, you’ll need a different kind of insurance: long-term care insurance. This type of insurance covers in-home care, assisted-living care, nursing-home care, and more, so you can get the help you require should a long-term care need arise.

What does Medicare cover?

Medicare is broken out into a few different parts:

• Part A covers inpatient hospital care and some skilled nursing care
• Part B covers doctor visits and preventative services
• Part C is additional coverage that can be purchased from a private insurer
• Part D covers prescription drugs

There is a narrow set of circumstances in which Medicare covers up to 100 days at a Medicare-certified skilled nursing facility (SNF).¹ (A skilled nursing facility is a nursing home that has additional medical professionals and provides additional services.) First, an inpatient hospital stay of three or more days must occur. Then, a doctor must determine that it’s medically necessary that the patient receive specialized nursing or rehabilitation. The care must be for the same condition that caused the hospitalization. The first 20 days are paid for completely, but there is a substantial co-payment (which may be covered if you have a Medigap policy) for the next 80 days. Medicare may also cover some in-home care from skilled nurses in similar situations if a person is certified by a doctor as homebound. In addition, if someone is terminally ill, hospice care is covered if the individual forgoes treatment intended to cure the illness. But hospice care does not cover room and board.

Does Medicaid pay for assisted living or long-term care?

Yes, if you qualify. Medicaid is a public assistance program that is run independently by each state and is funded by both the state and the federal government. Its primary goal is to provide health coverage to low-income families and individuals. Federal guidelines are loose, so there can be significant differences in eligibility requirements from state to state. Each state is different, but Medicaid usually covers a variety of long-term care services, such as nursing homes, assisted living, and in-home care.

How do I find out if my state’s Medicaid will cover long-term care?

To qualify, you must live in the state from which you wish to receive benefits and be a U.S. citizen or have permanent residence. You must fall below your state’s income and asset limits. These eligibility requirements vary by state, but they often require the individual to have an income of less than $2,829 a month and assets of less than $2,000 (not counting the individual’s primary residence).²

To learn the Medicaid eligibility requirements of your state and what your state covers, you can contact your state Medicaid agency. If you would like help examining your options, including long-term care insurance, you should speak to an agent.

What are my other options for long-term care?

It’s an unfortunate reality that many families are forced to pay out of pocket or sell off assets to pay for a family member’s long-term care. Another option is to have the elderly parent move in with a child. It’s best to prepare for the possibility that long-term care might be needed by saving a significant amount of money for long-term care or by investing in long-term care insurance.

Paying out of pocket

There are a few other ways to come up with the funds for long-term care. Each has pros and cons. Some life insurance policies have riders that allow the policy owner to access the death benefit to pay for long-term care. But this lowers the eventual death benefit. If you own your house outright, you might consider using the equity by taking out a home equity loan or by getting a reverse mortgage. But that often means that your family will not inherit it. Charities, church groups, and fundraising efforts are all potential sources of help.

Long-term care insurance

Similar to life insurance or disability insurance, a long-term care policy can be purchased to guard against the costs of daily care, whether it’s at home, in an assisted-living facility, or in a nursing home. There are many different types of policies and many options that you can put into place. It’s even possible to purchase a policy that has both life insurance and long-term care insurance in one solution. Our agents can help you find a solution that fits with your retirement strategy and safeguards your family’s finances.

RELATED CONTENT

¹“Skilled Nursing Facility (SNF) Care,” Medicare.gov, 2022.

²“Medicaid Eligibility, 2024 Income, Asset & Care Requirements for Nursing Homes & Long-Term Care,” American Council on Aging, January 29, 2024.

The purpose of this material is solicitation of individual insurance. An insurance agent may contact you. Policy forms ICC14-LTC6, LTC6, LTC6-U, ICC18-LTCD PLCY (0218), LTCD PLCY (0218), LTCD-U PLCY (0218), LTC6 (NY), LTCD PLCY (NY) (0218), and any state-specifics, are issued by New York Life Insurance Company, New York, NY. Policy forms ICC20-AF-MP, ICC20-AF-SP, AF-MP, AF-SP, AF-SP-NY, and AF-MP-NY, and any state-specifics, are issued by New York Life Insurance and Annuity Corporation, Newark, DE, a wholly owned subsidiary of New York Life Insurance Company, New York, NY. These policies have exclusions and limitations. The amount of benefits and premium depend on the product options selected. Underwriting approval is required to purchase coverage and a medical exam may be required. Premiums vary by issue age. The company reserves the right to increase premiums in the future on policy forms ICC14-LTC6, LTC6, LTC6-U, ICC18-LTCD PLCY (0218), LTCD PLCY (0218), and LTCD-U PLCY (0218), LTC6 (NY), and LTCD PLCY (NY) (0218). For costs and complete details of the coverage, contact your agent, or the company. New York Life Insurance Company and New York Life Insurance and Annuity Corporation each have sole financial responsibility for their own products.

This material may not provide complete details regarding all features and benefits offered by an NYL Secure Care, NYL My Care, or Asset Flex policy. In all cases, actual policy language will govern the administration of the contract. Benefits may vary by state. Check with your agent for specifics.

ICC22- 5058966 and 5058966