1. Understanding Assisted Living vs. Medical Care

To understand what Medicare covers, it’s important to know the difference between medical care and personal or custodial care. Assisted living provides help with daily activities such as bathing, dressing, meals, and medication reminders. Skilled nursing or medical care, by contrast, involves licensed medical professionals providing treatment or rehabilitation services.

💡 Medicare covers medical services — not room, board, or personal assistance — which are considered non-medical.

2. What Medicare Does Cover in Assisted Living

While Medicare won’t pay for the monthly rent or basic personal care in an assisted living facility, it does cover several important healthcare-related services that residents receive while living there.

Covered services include:

Doctor visits and medical evaluations (onsite or offsite)

Prescription medications under a Medicare Part D plan

Physical, occupational, and speech therapy (if medically necessary)

Lab work, X-rays, and preventive screenings

Hospitalization and skilled nursing stays (via Part A)

Durable medical equipment (DME) such as walkers, oxygen, or wheelchairs

Mental health and telehealth services under Part B

Example:

If a resident in assisted living needs wound care or physical therapy after surgery, Medicare Part B will typically cover those services, even if they occur onsite.

3. What Medicare Does Not Cover

It’s equally important to know what Medicare won’t pay for — because these are often the biggest expenses for families.

Not covered by Medicare:

Room and board in assisted living facilities

Custodial care (help with bathing, dressing, eating, toileting)

Laundry, housekeeping, and meal preparation

24-hour supervision or security

Transportation to non-medical activities

These costs fall under “long-term care”, which Medicare does not fund. Instead, families must rely on personal savings, long-term care insurance, or Medicaid (for low-income seniors).

4. How Medicare Advantage (Part C) Can Help

In 2025, many Medicare Advantage (Part C) plans offer extra benefits beyond Original Medicare — and some can help with limited assisted living-related services.

Potential benefits include:

Meal delivery and nutrition support after hospital discharge

Transportation to medical appointments

In-home caregiver support (short-term)

Home safety modifications (grab bars, ramps, fall sensors)

Personal care assistance for limited periods

Important note:

These benefits vary by plan and region, so it’s crucial to review your Medicare Advantage plan’s summary of benefits or speak directly with your insurer.

💡 Some Medicare Advantage plans partner with assisted living communities to coordinate onsite medical care, reducing out-of-pocket costs.

5. Medicare’s Short-Term Skilled Nursing Coverage

If a senior moves to a skilled nursing facility for rehabilitation after a hospital stay (not an assisted living home), Medicare Part A may cover it — temporarily.

Coverage timeline:

Days 1–20: $0 coinsurance (fully covered)

Days 21–100: Daily coinsurance ($200+ per day in 2025)

After 100 days: All costs out-of-pocket

To qualify, the patient must have:

A 3-day qualifying hospital stay prior to transfer

A physician’s certification that skilled care is required

This benefit is often misunderstood — it’s short-term rehab, not long-term custodial care.

6. How Medicaid Fills the Gap

For seniors with limited income or assets, Medicaid can help cover assisted living costs — something Medicare does not do.

Key Medicaid options:

Home and Community-Based Services (HCBS) waivers: May cover personal care in assisted living.

State-specific assisted living programs: Some states help pay room and board costs or care coordination.

Dual eligibility: Seniors who qualify for both Medicare and Medicaid receive the broadest support.

💡 Medicaid benefits and rules vary by state — contact your local Medicaid office or Area Agency on Aging for state-specific guidance.

7. Supplemental Options and Alternatives

To manage out-of-pocket costs, consider complementary financial strategies alongside Medicare.

Options include:

Long-Term Care Insurance: Covers personal care, assisted living, or nursing home costs.

Veterans Aid and Attendance (A&A) Benefits: Helps eligible veterans or surviving spouses pay for assisted living.

Life Insurance Conversions: Some policies can be converted into long-term care benefits.

Reverse Mortgages or Home Equity Loans: For homeowners needing liquidity for monthly care costs.

Each of these solutions can supplement the medical coverage Medicare provides.

8. Tips for Reducing Assisted Living Expenses

Compare facilities — pricing and included services vary widely.

Ask about “level-of-care” pricing, which charges only for the assistance you need.

Review your Medicare Advantage plan for potential supplemental services.

Combine Medicare with Medicaid or VA benefits if eligible.

Consider hybrid models like continuing care communities, which integrate medical and personal care.

Proactive financial planning — ideally 6–12 months before moving — can save thousands.