Does medicare pay for hospital bed in assisted living

Assisted living services can be beneficial for people who don’t have serious medical needs, but do need help with daily activities. Unfortunately, the average cost of assisted living arrangements can be steep. The amount typically paid to cover a private room in a nursing home is around $102,200 per year, according to a 2019 survey by Genworth. Less-expensive options like adult day health care still came to around $19,500 per year.

Will Medicare Pay for Assisted Living for Seniors?

No, in most cases Medicare doesn’t cover costs assisted living costs. Assisted living facilities are places devoted to providing help for various activities like eating, dressing, and bathing. They are meant to be a “home away from home” and aren’t designed to provide more extensive medical care.

Will My State Help Pay for Assisted Living?

Some states do offer an optional Social Security Insurance state supplement. It’s a cash assistance program that helps defray the costs of room and board. You can reach out to your local DHS or SSA office for more information.

In addition, Medicaid may be an option when it comes to getting help with assisted living costs. You may be eligible for Medicaid if you meet the following requirements:

• You are a U.S. citizen or a permanent resident
• Fall under the current Medicare income thresholds
• Have medical expenses that exceed a patient’s income
• Are a resident of the state that will be administering benefits

Facilities eligible for Medicaid coverage must meet specific requirements as well. The coverage of services depends on the benefits provided by a state’s Medicaid program. They typically offer benefits related to the following services:

• Personal care (eating, dressing, bathing assistance)
• Help with household chores
• Transportation
• Personal emergency response systems
• Case management

Does Medicare Cover Services Similar to Assisted Living?

While Medicare doesn’t provide coverage for assisted living or long-term care, it does provide some coverage for post-acute care.  Services must be prescribed as medically necessary by a physician for the treatment of an injury or illness, and include:

• Part-time or sporadic skilled nursing services
• Speech, occupational, or physical therapy services administered by a home health agency certified by Medicare
• Social services related to medical care to help patients get through cultural, psychological, and medical problems arising from an illness
• Durable medical equipment (DME) and medical supplies like oxygen, hospital beds, and wheelchairs

Medicare also usually covers short stays in a skilled nursing facility. It’s important to keep in mind that for most services Medicare covers, it only pays up to 80%, after deductibles and copays.  

Do Medicare Supplement Plans Cover Assisted Living?

Medicare Supplements are secondary to Medicare, so they only pay if Medicare pays first. This means that a Medicare Supplement won’t cover assisted living costs, because Medicare doesn’t cover them. If Medicare approves long-term care costs such as a stay in a skilled nursing facility, your Medicare Supplement plan will pay its part.

Do Medicare Advantage Plans Cover Assisted Living?

 If you have a Medicare Advantage plan, you’ll need to check your policy for details on your coverage. These plans don’t cover assisted living, but some may offer similar benefits such as adult day care or transportation services.

Ultimately, while Medicare covers a wide range of medically necessary services, it doesn’t offer assisted living benefits. If you or someone you know needs assistance with assisted living costs, you can check to see if you qualify for any of your state’s benefits.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

En español | No, Medicare does not cover any type of long-term care, whether in nursing homes, assisted living communities or your own home.

Medicare does cover medical services in these settings. But it does not pay for a stay in a long-term care center or the cost of custodial care — help with the activities of daily living, such as bathing, dressing, eating and using the bathroom — if that is the only care you need.

Does Medicare cover short-term stays for skilled nursing?

Yes, Medicare Part A, which covers inpatient hospital services, will pay for short-term stays in a Medicare-certified skilled nursing facility (SNF) in some situations. Your doctor may send you to there to receive specialized nursing care and rehabilitation after a hospital stay.

Care in a skilled nursing facility is covered only if you had a qualifying hospital stay, meaning that you were formally admitted as an inpatient to the hospital for at least three consecutive days. This is different from observation status, which doesn’t count even if you stayed in the hospital overnight.

When you enter the hospital, ask if you are being officially admitted or if you are there only for observation. That will be important in determining the beginning of your benefit period, which begins the day you are admitted to a hospital as an inpatient or become a patient in a skilled nursing facility , and ends when you’ve been out of those places for 60 days in a row. These rules also mean you might have more than one benefit period in a year.

You must be admitted to a skilled nursing facility within 30 days of leaving the hospital for the same illness or a condition related to it. Your doctor also must certify that you need daily skilled care from, or under the supervision of, skilled nursing or therapy staff.

What skilled nursing facility costs does Medicare cover?

Medicare can cover many of the services you receive in a skilled nursing facility, such as:

• A semiprivate room and meals

• Skilled nursing care

• Medical social services and dietary counseling

• Medications, medical equipment and supplies used in the facility

• Occupational therapy, physical therapy or speech and language pathology services if needed to meet your health goal

• Ambulance transportation if needed to receive necessary services that aren’t available in the facility

How much do I pay if I’m in a skilled nursing facility?

The portion of the costs that you pay depends on the duration of your eligible stay in a skilled nursing facility. You’ll have the following copayments for each benefit period:

• $0 for days 1 to 20

• $194.50 a day in 2022 for days 21 to 100

• All costs day s 10 1 and beyond

A Medicare supplemental policy, better known as Medigap; retiree coverage; or other insurance may cover the copay for days 21 to 100 or add more coverage.

Keep in mind

Medicare doesn’t pay for the considerable cost of long-term care in a nursing home or other facility. But you may have other options to help cover long-term care costs.

Private pay. Many individuals and families pay out of pocket or tap assets such as property or investments to pay for long-term care. If they use up those resources, Medicaid may become an option.

Long-term care insurance. Some people buy long-term care insurance that may pay for custodial care in a nursing home or assisted living facility or for a caregiver to come to their home. To qualify for payouts, you generally must need help with at least two activities of daily living (ADLs) or provide evidence of cognitive impairment.

Veterans benefits. Military veterans may have access to long-term care benefits from the U.S. Department of Veterans Affairs (VA). 

Medicaid. The federally financed but state-run health program that provides coverage to people with low incomes pays a considerable portion of America’s nursing home bills. Medicaid eligibility varies by state but requires strictly limited income and financial assets.

Updated July 19, 2022