A nurse and a senior in a skilled nursing home.

Understanding Medicare and Medicaid Coverage for Assisted Living

Assisted living costs vary depending upon many things like the location and type of the facility, the services availed, the amenities included in the care plan, and more. This could be very high in certain locations, which may stretch the family budget. That is why it would always be better to understand how Medicare and Medicaid may help you with assisted living costs.


Medicare is the government-funded national health insurance for all American citizens above the age of 65. In general, Medicare has four parts – Hospital Insurance, Medical Insurance, Medicare Advantage, and Prescription Drug Coverage.

Medicare Part A (Hospital Insurance) helps seniors to pay the costs of inpatient care in a healthcare facility or skilled nursing home post-hospitalization. It also covers certain home health care and hospice care costs. Medicare Part B (Medical Insurance) covers the costs of doctors’ services and certain medical services and supplies that are not included in Medicare Part A.

Medicare Part C (Medicare Advantage) is available in some states where seniors with Medicare Part A and Part B can receive all the benefits through dedicated provider organizations. Medicare Part D (Prescription Drug Coverage), on the other hand, covers medications prescribed by the doctors for the treatment.

Note that Medicare only covers the costs of short-term and non-custodial senior care services, which means that you cannot use it to pay for assisted living expenses. That is because assisted living focuses on long-term care mainly. Yet again, there are some instances, where Medicare may be used to cover some of the health care services in an assisted living facility. You will need to consult with the assisted living community to learn about what types of payments they accept.


Medicaid refers to government-funded health care assistance for low-income individuals. In other words, seniors who cannot afford to pay for their care services can avail Medicaid benefits for the needed long-term care services.

Medicaid is provided by the federal government and state authorities cooperatively. Note that the eligibility criteria for Medicaid will vary by the state; however, the federal government mandates that all states should cover certain communities. Seniors with disabilities are eligible for Medicaid in all states, whereas those without any disability will need to prove that they need senior care services but cannot afford to cover the costs of care.

Medicaid also acts as health insurance coverage just like Medicare, but the difference here is that Medicaid covers almost all kinds of senior care services, including long-term care costs. Even though every state has its own criteria and regulations, seniors can use Medicaid to pay for the majority of costs in an assisted living facility.

You can refer to the Medicaid Waiver programs available in your state or contact the local Medicaid office, Department of Elder Affairs, or Department of Aging to find a Medicaid-approved assisted living facility.