Does Medicare Cover Assisted-Living or Nursing Home Care?

More than 46 million people were enrolled in Medicare in 2010, according to the Kaiser Family Foundation. Medicare is designed for and used mainly by senior citizens 65 or older. Though Medicare provides health insurance benefits for preventative and hospital care, there comes a time when many families look into assisted-living or nursing home care for elderly members. As of 2011, Medicare does not offer any benefits for assisted-living communities or custodial nursing home care. In some circumstances, short-term nursing facility care is covered, however.

Assisted-Living Facilities

• Assisted-living facilities are often used by seniors who cannot live on their own but are not ill enough to need the constant medical care of a nursing home. They receive help with laundry, transportation, meals and personal care while still retaining privacy and a certain level of independence. Assisted-living facilities can be expensive, however. As of 2011, Medicare will not cover the costs of residing in an assisted-living facility. It will, however, continue to cover qualifying health care services as if a beneficiary were living on her own.

Nursing Homes

• Medicare does not pay for long-term custodial care in a nursing home or skilled-nursing facility. It does offer benefits for short-term stays that are related to treatment recently received at a hospital. If a patient has had a qualifying inpatient hospital admittance of at least three days, Medicare will help pay costs of staying in a nursing or rehabilitation facility. If not, there are no Medicare benefits for it.

Respite Care

• Medicare Part A offers a hospice benefit. Hospice care is provided to terminally ill patients in their last six months. They generally receive their care at home by members of the family and authorized medical personnel. If a person is getting Medicare-covered hospice services, a short-term respite benefit can be used. This allows the patient to stay in a nursing home, hospital or inpatient hospice facility for up to five days at a time to relieve the usual caregivers. As of 2011, there is no limit on the number of times hospice patients can use the respite benefit.

Program of All-Inclusive Care for the Elderly (PACE)

• PACE is meant as an alternative to custodial nursing-home care. It is an optional Medicare benefit that offers coverage for medical and social services that can be provided at an adult day health center. PACE users can get services from social workers, dietitians, nurses, therapists and physicians, depending on need. A beneficiary must voluntarily enroll in PACE and live in a PACE service area to receive benefits.