Assisted living offers a supportive environment for older adults, blending independence with assistance for daily activities like medication management, dressing, and housekeeping. While it’s a vital option for many families, the cost of assisted living can be a concern.
What is assisted living?
Assisted living facilities cater to older adults who need help with daily activities but do not require intensive medical care like that offered in nursing homes. These facilities range from basic accommodations to upscale residences with amenities like fitness centers, libraries, and spas. With over 30,600 such facilities across the U.S., assisted living is a growing solution for the aging population.
Does Medicare cover assisted living?
Original Medicare (Parts A and B)
Original Medicare does not cover the costs of assisted living because it is not considered medically necessary. However, it covers some short-term stays in skilled nursing facilities after a qualifying hospital stay, subject to specific conditions.
For instance, Medicare Part A fully covers the first 20 days in a skilled nursing facility, but patients must pay $204 per day for days 21-100. Beyond 100 days, costs are entirely out-of-pocket.
Medicare advantage (Part C)
Medicare Advantage plans, offered by private insurers, provide benefits similar to Original Medicare and may also include additional perks like meal delivery or transportation for medical appointments. While these plans do not directly cover assisted living costs, they may offer coverage for certain supportive services provided in such facilities.
Medigap (Supplemental insurance)
Medigap policies are designed to cover costs that Original Medicare doesn’t, such as deductibles and copayments. However, these plans do not extend coverage to assisted living. Instead, they focus on relieving short-term out-of-pocket expenses.
Medicaid and assisted living
Unlike Medicare, Medicaid offers some assistance with assisted living expenses, but with limitations. Medicaid does not cover room and board in assisted living facilities. However, many states have Medicaid waiver programs that help cover services such as medication management and therapy within residential settings. Eligibility for Medicaid is income-based, and specific benefits vary by state.
Alternatives to Medicare and Medicaid for assisted living costs
If Medicare and Medicaid do not meet your needs, other options include:
- Long-Term care insurance: Some policies cover assisted living, depending on their terms. Research is essential to understand coverage limits.
- Veterans’ benefits: Eligible veterans can receive support for assisted living through programs offered by the Veterans Administration.
- Reverse mortgages: These allow homeowners to use their property’s equity to fund long-term care, but they come with risks and require careful planning.
- Private funds: Many families rely on personal savings, pensions, or retirement accounts to pay for assisted living.
Cost of assisted living in the US
The cost of assisted living varies by state and facility amenities. For example, the average monthly cost in Massachusetts was $6,500 in 2021, compared to $4,500 in Texas and $3,748 in Louisiana. Understanding regional cost variations is crucial for effective planning
