As the aging population grows, many families seek financial assistance to cover the costs of assisted living. Two of the most common government-funded healthcare programs—Medicaid and Medicare—can provide some benefits, but their coverage varies significantly. Understanding what each program offers is crucial for those planning long-term care for themselves or their loved ones.
Medicare and Assisted Living
Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as some younger people with disabilities. However, Medicare does not cover the cost of assisted living or long-term custodial care. Assisted living facilities typically provide help with daily activities like bathing, dressing, and medication management, which Medicare classifies as “custodial care” rather than medical care.
That said, Medicare may still cover certain healthcare services for those in assisted living, such as:
- Skilled nursing care (e.g., after hospitalization)
- Physical, occupational, and speech therapy
- Medical supplies and equipment (e.g., wheelchairs or walkers)
- Doctor’s visits and preventive care
If a senior requires short-term rehabilitation in a skilled nursing facility after a hospital stay, Medicare Part A may cover up to 100 days of care under specific conditions. However, once a person transitions to a long-term assisted living setting, Medicare does not help with the facility’s cost.
Medicaid and Assisted Living
Medicaid, a joint federal and state program, provides healthcare coverage to low-income individuals, including seniors who need long-term care. Unlike Medicare, Medicaid can cover some assisted living costs, but the extent of coverage depends on the state and the specific Medicaid program.
Medicaid Waivers for Assisted Living
Many states offer Medicaid Home and Community-Based Services (HCBS) waivers that help cover the cost of assisted living for eligible seniors. These waivers can provide:
- Personal care services (help with daily activities)
- Case management
- Nursing services
- Therapies and medication administration
However, Medicaid typically does not cover room and board costs in assisted living. Instead, it helps pay for care services within these facilities. Some states have programs to assist with housing costs, but eligibility and benefits vary.
Medicaid Eligibility for Assisted Living
To qualify for Medicaid-assisted living benefits, seniors must meet both financial and medical eligibility requirements. Generally, they must:
- Have limited income and assets – Income limits vary by state, but many require individuals to have income below a certain threshold (often near the federal poverty level).
- Demonstrate a need for care – Seniors must show they need assistance with activities of daily living (ADLs), such as dressing, eating, or mobility.
Each state has different rules, so it’s essential to check local Medicaid guidelines or consult a Medicaid planner for assistance.
How to Apply for Medicaid Assistance for Assisted Living
- Check your state’s Medicaid program – Visit your state’s Medicaid website or speak with a local Medicaid office.
- Gather financial and medical documents – Proof of income, assets, and medical assessments may be required.
- Apply for Medicaid benefits – You can apply online, by mail, or in person, depending on your state’s process.
- Explore HCBS waivers – If Medicaid covers assisted living in your state, apply for the relevant waiver programs.
Conclusion
While Medicare does not cover assisted living costs, Medicaid may offer financial assistance for care services through state-run programs and waivers. If you or a loved one is considering assisted living, researching Medicaid eligibility and state-specific benefits is essential for finding financial support. Consulting a Medicaid planner or elder care expert can also help navigate the application process and maximize available benefits.