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Does Medicare Cover Assisted Living?

By Maurie Backman - Dec 18, 2017 at 5:04PM

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If you're counting on Medicare to pay for an assisted living facility, you're out of luck. But that doesn't mean you won't manage to afford one.

It's estimated that 70% of seniors 65 and over will end up needing some type of long-term care, whether it's a nursing home or an assisted living facility. Assisted living facilities are designed to help seniors retain some degree of independence by providing what's known as custodial care, which encompasses help with functions such as bathing and dressing. Nursing homes, by contrast, are generally more suitable for seniors with medical issues or who need active monitoring.

If you're struggling to function on your own but aren't at the point where you need a nursing home, it pays to look into the assisted living communities in your area -- assuming you can afford one. Unfortunately, assisted living doesn't come cheap. And the kicker? Medicare won't help pay for it.

Group of seniors hanging out while a woman in scrubs smiles and talks to them

IMAGE SOURCE: GETTY IMAGES.

Medicare has its limitations

Though Medicare provides critical health benefits to millions of retired seniors, there are certain services it won't cover, like dental care, vision care, and long-term care, which includes assisted living. The services offered by most assisted living facilities generally fall under the category of custodial care, which Medicare won't pay for because it's not medical care in the traditional sense.

On the other hand, Medicare will pay for a home health aide or skilled nursing facility if you require specialized care following a surgery or injury. The difference, however, is that in this sort of situation, you'd need more than just custodial care to recuperate properly. Furthermore, if you land in a skilled nursing facility, Medicare will typically limit the number of days you get coverage for. (In other words, don't get too comfortable there.)

Affording the care you need

Since Medicare won't cover assisted living, you'll need to be prepared to pay for it solo. And, unfortunately, it doesn't come cheap. Genworth Financial reports that the average assisted living facility in the country costs $3,628 per month, or $43,539 per year. And that's not a cost the typical retiree can afford to absorb.

Thankfully, there is a solution, and it's called long-term care insurance. If you purchase insurance when you're younger, it'll help defray the cost of assisted living when you eventually come to need it. And the sooner you apply, the greater your chances of not only getting approved for coverage but snagging a health-based discount.

According to the American Association for Long-Term Care Insurance, more than 50% of long-term care insurance applicants in their 50s wind up qualifying for health-based discounts. That percentage drops to 42%, however, among applicants in their 60s, and it dives down to 24% for those who wait until their 70s to apply. If you're serious about keeping your long-term care costs at a manageable level, then it pays to look into insurance before your health begins to decline.

Another strategy for swinging your long-term care costs? Save more during your working years. At present, workers 50 and over can sock away up to $24,000 a year in a 401(k) and $6,500 a year in an IRA. Come 2018, the former limit will increase by another $500. If you work on maxing out your retirement plan contributions for the last decade or so of your career, you'll have an easier time affording whatever healthcare costs come your way in the future.

Finally, stay informed about long-term care costs so that if you do wind up needing to move to an assisted living facility, you're not hit with too much sticker shock. Like it or not, Medicare won't be covering the cost of assisted living anytime soon, so you'll need to take matters into your own hands -- both now and in the future.

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