Does Medicare or Medicaid Pay for Senior Living? 

What is Medicare?

Medicare is a federal health insurance program primarily for people age 65 and older, as well as certain younger people with disabilities or specific medical conditions. Medicare Part A helps cover inpatient hospital care, eligible short-term skilled nursing facility care, hospice care, and certain home health services. Part B helps cover medically necessary services such as doctor visits, outpatient care, ambulance services, and durable medical equipment.

Medicare does not cover 100% of healthcare costs. Depending on the service and coverage, beneficiaries may have deductibles, coinsurance, or other out of pocket costs. Some people choose supplemental coverage, such as Medigap or Medicare Advantage, to help manage these expenses.

Medicare Benefits for Senior Care

Medicare generally does not cover the cost of senior living, assisted living, or long term custodial care. However, Medicare can continue to cover eligible medical services while a person lives in a senior living community, depending on the service and coverage requirements.

What Does Medicare Cover?

Assisted Living
Medicare does not pay for the cost of assisted living, including room and board. However, Medicare can continue to cover eligible medical services, such as doctor visits, hospital care, certain procedures, and other covered services while you live in an assisted living community. Medicare Advantage plans provide Medicare Part A and Part B coverage through private health plans and may offer additional benefits depending on the plan. Learn more

Skilled Nursing and Rehabilitation
Medicare Part A may cover eligible short-term skilled nursing facility care for up to 100 days per benefit period when certain conditions are met. Medicare covers the full approved cost for days 1–20. For days 21–100, a daily coinsurance amount applies. Medicare generally does not cover long term custodial care in a nursing home.

Medicare-Certified Agencies.
Medicare may cover eligible home health services, including skilled nursing and physical, occupational, or speech therapy, when certain requirements are met. These services may be provided in a private home or while a person lives in an independent or assisted living community. Medicare does not cover the cost of room and board in these settings.

What is Medicaid?

Medicaid is a joint federal and state program that provides health coverage to eligible people with limited income and resources, including some seniors and people with disabilities. Because each state administers its own Medicaid program within federal requirements, eligibility, covered services, and benefits can vary by state.

Medicaid Benefits for Senior Care

To qualify for Medicaid long term care services, seniors must meet their state’s Medicaid eligibility requirements. Depending on the program and service, eligibility may consider income, resources, functional needs, and other state specific criteria.

Skilled Nursing
Medicaid can cover nursing facility care for eligible individuals who meet their state’s Medicaid requirements and need the level of care provided by a Medicaid certified nursing facility. Covered services may include long term nursing care and related services, with coverage and eligibility requirements varying by state.

Medicaid financial eligibility is based on state specific income and resource rules. In some circumstances, an individual may need to spend down countable assets to meet the applicable Medicaid resource limit, but the rules vary by state and circumstances.

Assisted Living
However, not everyone who needs long-term care necessarily needs 24/7 skilled nursing care and may have their needs better met in an assisted living community.

Medicaid may help cover certain care and support services for eligible residents of assisted living communities, depending on the state and Medicaid program. Medicaid generally does not pay the full cost of assisted living room and board, but some states may cover eligible services such as personal care or other long term services and supports.

• Personal care
• On-site therapy
• Medication management
• Outpatient hospital services not covered by Medicare
• Home health services
• Prescription drugs
• Eyeglasses and hearing aids
• Hospice care
• Co-pays for hospitalization and skilled nursing care not covered by Medicare

Applying for Medicaid

Applying for Medicaid can be complicated because each state has its own eligibility requirements, covered services, and application process. To learn whether you qualify and which services may be covered, contact your state Medicaid agency or a local aging and social services organization. Find your local state resources here