Key Takeaways

• Medicare does not cover the full cost of assisted living, but it may help with some medical services you receive while residing in such a facility.

• Understanding which parts of Medicare apply to skilled care, home health services, and prescription drugs can reduce out-of-pocket expenses while in assisted living.

Why Assisted Living Costs Add Up Quickly

Assisted living communities offer a range of support, from help with daily activities to coordinated medical care. However, most of the cost is tied to room, board, and personal care services, which Medicare does not cover. These are considered custodial in nature, meaning they don’t meet the definition of medically necessary care that Medicare pays for.

In 2025, the average national cost of assisted living continues to range in the thousands of dollars per month. The actual amount depends on location, level of care, and additional services. Because these expenses are considered non-medical, they fall outside Medicare’s direct payment structure.

Still, not everything is excluded. Certain medical needs that arise while you’re living in an assisted facility may qualify for Medicare coverage—you just need to know what’s included and how to access it.

What Medicare Pays for in an Assisted Living Setting

While Medicare doesn’t pay for the facility itself, it does cover medically necessary services you receive during your stay.

Covered Medical Services

Medicare may pay for:

• Physician visits and consultations

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

• Skilled nursing care, if ordered by a doctor and meeting specific conditions

• Physical, occupational, or speech therapy

• Mental health services

• Lab tests and diagnostic imaging

• Outpatient services like chemotherapy or dialysis, if needed

These services are typically covered under Medicare Part B, which handles outpatient care, physician services, and preventive screenings.

Home Health Benefits in Assisted Living

If you’re homebound (as defined by Medicare) while in an assisted living facility and need intermittent skilled nursing or therapy, Medicare Part A or Part B may cover a series of home health visits.

Covered home health services may include:

• Skilled nursing care (intermittent)

• Physical or occupational therapy

• Medical social services

• Certain home health aide services (only if you also require skilled care)

The key is that these services must be ordered by a doctor and provided by a Medicare-certified home health agency.

What Medicare Does Not Cover

Despite these benefits, several essential components of assisted living are not reimbursed by Medicare:

• Room and board

• Meal plans and food services

• Assistance with bathing, dressing, or toileting (unless part of skilled home health care)

• Housekeeping and laundry services

• 24/7 supervision or emergency response systems

These are considered personal or custodial services, which fall outside of Medicare’s scope. This distinction is critical when budgeting for long-term assisted living.

Medicare Advantage Plans: A Possible Supplement

Some people choose to enroll in Medicare Advantage plans, which are alternatives to Original Medicare offered by private insurers. These plans may offer additional benefits beyond traditional Medicare. However, it’s important to understand that assisted living room and board still aren’t covered, even under Medicare Advantage.

That said, you may have access to:

• Transportation to medical appointments

• Routine vision, hearing, and dental care

• Over-the-counter allowances

Coverage varies significantly between plans and regions. It’s important to read your plan documents carefully or speak with a licensed agent listed on this website.

Medicaid: An Important Companion for Some

While Medicare offers only limited help for assisted living, Medicaid plays a larger role for individuals with low income and limited resources. In many states, Medicaid can help pay for custodial care in licensed assisted living facilities under a Home and Community-Based Services (HCBS) waiver.

Eligibility requirements and benefits vary by state, but many people use Medicare for medical services and Medicaid for long-term support. This dual-eligibility scenario is common among those with chronic health conditions and modest financial means.

To qualify for Medicaid, you must meet income and asset limits, which change annually. In 2025, many states use a monthly income cap around $2,800 for a single applicant, though this can vary. Additionally, asset thresholds are generally low, but some exemptions apply (such as a primary home).

Planning Ahead with Medicare’s Limitations in Mind

If assisted living is likely to be part of your future, financial preparation is essential. Medicare’s role is limited to medical care, not the broader costs of living in a facility. Understanding this helps you prepare more thoroughly.

You should:

• Review your Medicare coverage to understand what services are included

• Explore long-term care insurance if you’re still healthy and eligible

• Research your state’s Medicaid programs in case future support is needed

• Speak with a licensed agent for help comparing Medicare Advantage and Part D drug plans, if applicable

It’s also helpful to work with a financial advisor who understands long-term care options. They can help you build a plan that complements your Medicare benefits while accounting for what’s not covered.

Understanding Short-Term Stays in Skilled Nursing Facilities

Some individuals confuse skilled nursing care with assisted living. These are distinct levels of care. Medicare will pay for short-term stays in a skilled nursing facility (SNF), but only when specific criteria are met:

• You must have had a qualifying inpatient hospital stay of at least three consecutive days

• A doctor must certify that you need daily skilled care

• The facility must be Medicare-certified

In 2025, Medicare covers:

• Days 1–20: Full cost of approved SNF services

• Days 21–100: A daily coinsurance applies

• After day 100: No further coverage from Medicare

This benefit is separate from assisted living and should not be confused with long-term custodial care.

Prescription Drug Coverage While in Assisted Living

Medicare Part D provides outpatient prescription drug coverage. Whether you’re living at home or in an assisted living facility, this benefit remains active, as long as you’re enrolled in a Part D plan.

Covered drugs typically include those used to treat chronic conditions like:

• Hypertension

• Diabetes

• Arthritis

• High cholesterol

• Osteoporosis

You may fill prescriptions through local pharmacies or mail-order services. Some assisted living facilities coordinate this for residents, but Medicare does not pay for the facility’s help with medication management—it only pays for the medications themselves (minus applicable deductibles and copayments).

What About Hospice in an Assisted Living Setting?

If you qualify for Medicare’s hospice benefit, you can receive these services even while living in an assisted living facility. Hospice under Medicare includes:

• Palliative care for terminal illness

• Pain and symptom management

• Emotional and spiritual support

• Support for family caregivers

To qualify, your doctor must certify that you are expected to live six months or less, and you must agree to forgo curative treatment. The facility itself is not paid by Medicare, but the hospice agency is.

Don’t Overlook Annual Preventive Services

Even while residing in assisted living, you are entitled to all standard preventive services under Medicare Part B. These include:

• Annual Wellness Visits

• Vaccinations (flu, pneumonia, shingles, COVID-19)

• Screenings for cancer, diabetes, heart disease, and more

These services can help catch or manage chronic conditions before they worsen, potentially keeping you independent longer and reducing the need for higher levels of care.

The Bottom Line on Medicare and Assisted Living

Medicare can support some of your healthcare costs while in an assisted living facility, but it does not pay for the cost of the facility itself. You need to plan accordingly.

Key steps include:

• Clarifying what services are covered under Medicare

• Learning whether Medicaid can provide additional support

• Staying current with your Medicare Part D drug plan

• Exploring long-term care insurance and financial strategies

To get the most out of your Medicare benefits and to discuss how different plans may affect your future care, get in touch with a licensed agent listed on this website.