How Much Does Medicare Pay Toward Assisted Living? A Complete Guide

Oct 26, 2025 4 min read •

senior care Medicare assisted living

Over 50% of adults aged 65 and older will need some form of long-term care, according to the U.S. Department of Health and Human Services. For those considering their options, understanding precisely how much does Medicare pay toward assisted living is a critical first step.

Quick Summary

Medicare does not cover the non-medical costs of assisted living, such as room and board. Its coverage is restricted to medically necessary services, though some medical care received within a facility may be covered, leaving custodial costs for other payment methods.

Key Points

Limited Coverage: Medicare does not cover the primary costs of assisted living, including room and board and personal care assistance.
Custodial vs. Skilled Care: Medicare covers skilled medical care (e.g., therapy) but not the non-medical, daily living assistance considered custodial care.
Alternate Payment Methods: Assisted living is most often paid for through alternative sources such as personal savings, long-term care insurance, or specific government programs.
State-Specific Medicaid: Medicaid waivers may help cover some personal care costs in an assisted living setting, but eligibility varies by state and generally does not cover housing.
Medicare Doesn't Supplement: Neither Medicare Advantage (Part C) nor Medigap (Medicare Supplement Insurance) plans are designed to cover long-term custodial care.

Understanding Medicare's Core Limitations

At its core, Medicare is federal health insurance primarily designed to cover medically necessary services and treatments. This includes hospital stays, doctor visits, and certain skilled care. The key distinction lies in its coverage of medical care versus what it defines as “custodial care.” Assisted living falls into the latter category, as its primary purpose is to provide residents with non-medical assistance for daily living activities.

Custodial Care vs. Skilled Care

Medicare's policy is based on the type of care required, not the setting in which it is received. Custodial care, which is the main service offered in assisted living, includes help with daily tasks like bathing, dressing, eating, and medication reminders. This type of care is not covered by Original Medicare (Parts A and B). In contrast, skilled care is medically necessary care provided by a qualified professional, such as a physical therapist, occupational therapist, or a registered nurse. This is the only type of long-term care that Medicare may cover, and it is almost always limited to a short-term period following a qualifying hospital stay.

What Medicare Might Cover While in Assisted Living

While the assisted living facility's general costs are not covered, certain medically necessary services you receive while a resident may still be. Your Medicare benefits, just as they would if you were living at home, will apply to approved healthcare services.

Doctor's Visits: Outpatient services, including appointments with your physician, are covered under Medicare Part B.
Rehabilitative Therapies: Physical, occupational, and speech therapy can be covered by Part B if a doctor prescribes them as medically necessary. These services may be offered on-site in some facilities.
Medical Equipment: Durable medical equipment (DME), such as walkers, wheelchairs, and oxygen equipment, is covered under Medicare Part B if prescribed by a doctor.
Medications: Prescription drugs are covered by a separate plan, Medicare Part D, which an assisted living resident must enroll in separately.

The Role of Medicare Advantage and Medigap

It is a common misconception that private Medicare plans, like Medicare Advantage (Part C), will cover the full costs of assisted living. These plans must provide at least the same level of coverage as Original Medicare and still generally do not cover custodial care or room and board. However, some Advantage plans may offer additional benefits that can be used for services related to assisted living, such as transportation to doctor appointments or meal delivery for a limited time. Medigap policies, or Medicare Supplement Insurance, also do not cover assisted living, as they are designed to pay for the out-of-pocket costs associated with Original Medicare, not services Medicare does not cover at all.

Alternative Funding Options for Assisted Living

Given Medicare's limitations, most families need to explore other avenues to cover the significant expenses associated with assisted living. These options often require careful planning.

Medicaid and State Waiver Programs: While Medicaid is primarily for individuals with low income and assets, many states offer Home and Community-Based Services (HCBS) waivers. These programs can provide financial assistance for certain services in an assisted living setting, though they do not typically cover room and board. Eligibility criteria and covered services vary significantly by state.
Long-Term Care Insurance: For those who purchased a policy in advance, long-term care insurance is a dedicated plan that can cover the costs of assisted living, home care, and nursing home care. Policies have waiting periods and specific benefit limits, so reviewing the policy details is essential.
Veterans' Benefits: The U.S. Department of Veterans Affairs offers the Aid and Attendance benefit to eligible veterans and their surviving spouses. This tax-free pension supplement can help cover the costs of a long-term care facility, including assisted living.
Personal Savings and Assets: Many individuals use a combination of personal resources, such as retirement savings, pensions, Social Security income, and liquidating assets. For homeowners, selling their property or obtaining a reverse mortgage are also common strategies.

Comparison of Assisted Living Payment Methods


Payment Method	Covers Room & Board?	Covers Personal Care?	Common Use Case
Original Medicare	No	No	Medically necessary services within the facility.
Medicare Advantage (Part C)	No	Limited/Rarely	Supplemental benefits like transportation; medical services.
Medicaid Waiver (State Dependent)	No (often)	Yes (partial/full)	Low-income individuals needing care in a specific state.
Long-Term Care Insurance	Yes (often)	Yes	Policyholders needing care after the elimination period.
VA Aid and Attendance	Yes (partial/full)	Yes (partial/full)	Eligible veterans and their spouses.
Personal Funds/Savings	Yes	Yes	Independent financing for those with sufficient resources.

The Crucial Takeaway

In conclusion, Medicare provides little to no coverage for the foundational costs of assisted living. It is a health insurance plan, not a long-term care provider. The distinction between medical and custodial care is the primary reason for this coverage gap. Residents must look to other financial strategies, including Medicaid waivers, veterans' benefits, and private funds, to cover the bulk of assisted living expenses. Understanding this limitation early is the best way to plan for the future and ensure you or your loved one receives the care needed.

Learn more about Medicare's definition of long-term care services on Medicare.gov

Frequently Asked Questions

No, neither Medicare Part A (Hospital Insurance) nor Part B (Medical Insurance) covers the costs associated with assisted living, such as room and board or custodial care. They will, however, cover medically necessary services you receive while residing in the facility, just as they would otherwise.

While Medicare Advantage (Part C) plans sometimes offer supplemental benefits beyond Original Medicare, they typically do not cover the full cost of assisted living. They still operate under Medicare's distinction between medical and custodial care. Some plans may offer limited benefits, like transportation, but this is rare and not a substitute for comprehensive coverage.

Yes, Medicare Part B will help cover the cost of a hospital bed if it is considered durable medical equipment (DME) and is prescribed by a doctor as medically necessary. This coverage applies whether you are in an assisted living facility or at home, but Medicare won't cover the bed's full cost.

Medicare does not pay for any days of assisted living. However, it may cover up to 100 days of care in a skilled nursing facility if you meet specific eligibility requirements, which include a qualifying hospital stay of at least three consecutive days before admission.

No, Medigap policies are designed to cover the gaps in Original Medicare, such as copayments and deductibles for covered services. They do not extend to long-term custodial care like assisted living, which is not covered by Medicare.

Skilled care is medically necessary treatment provided by a licensed medical professional, like a physical therapist or nurse. Custodial care is non-medical assistance with daily tasks, such as bathing, dressing, and eating. Medicare only covers skilled care, not custodial care.

Medicare coverage is based on the type of care needed, not the medical condition. Therefore, it will not cover the assisted living expenses for someone with dementia. However, it may cover specific medical services or therapies required, just as it would for any other condition.

References

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.