Many people have to consider moving into assisted living due to age, illness, or injury. As we get older, an assisted living facility can sometimes provide the care and services that make life easier. An assisted living facility may offer a variety of benefits, ranging from social activities, community services, healthy meals, and care. Medicare has strict policies when it comes to covering care facilities, but understanding assisted living and Medicare coverage will help you determine your costs.

What is Assisted Living? 

The terms “assisted living facility” and “nursing home” are commonly used interchangeably. However, these two living situations can be quite different in their structure and management. Assisted living facilities generally more closely resemble a nice, upscale apartment complex. These complexes have pleasant outdoor spaces, well-managed grounds, and recreational spaces, like a pool or tennis court.

Assisted living is different from a nursing home or skilled nursing facility, where doctors and nurses serve as caregivers. Individuals in skilled nursing facilities usually suffer from complex medical issues that require monitoring and treatment. Nurses and physicians are on-site all the time and are able to provide medication, utilize medical equipment, and monitor health levels.

On the other hand, assisted living allows residents to live on their own while providing community events, a secure environment, a healthy and balanced food plan, and much more. Residents are able to get help with medication management, be surrounded by many friends, and receive laundry and transportation services.

Assisted living allows adults to maintain their independence while living alone, but they are also provided with a great support system and community to make their lives more enjoyable and easier. This environment can be very helpful for older individuals and help to ensure that they live a healthy lifestyle.

Does Medicare Cover Assisted Living? 

In most cases, assisted living facilities are not included in Medicare coverage. In general, Medicare coverage is only provided for “medically necessary” services or supplies. Since assisted living facilities do not administer patient-specific healthcare, they are usually not included in this category. Assisted living facilities are not usually covered by Medicare because they are designed to provide custodial care, meal preparation and serving, and a secure and social atmosphere for residents. Individuals living in an assisted living facility do not require consistent medical services. The residents are able to function on their own and do not require daily care and supervision.

If the health of a resident in an assisted living facility declines and they require additional medical support, a move to a skilled nursing facility or to a hospital setting may be recommended. Medicare Part A covers inpatient stays, procedures, and supplies. Some examples of facilities that do qualify for coverage from Medicare Part A are inpatient hospital stays, skilled nursing facility, hospice care, and certain home health services. Some of these home services may include physical or occupational therapy treatments, social services, or speech-language pathology services.

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