Medicare Benefits for Assisted Living

Medicare benefits for assisted living depend on the type of care that is being provided. Medicare generally does not pay benefits for assistance with daily activities, such as eating and dressing. However, Medicare covers therapeutic assistance in the home if you are recovering from a surgery or illness. This coverage is limited, and there are several requirements that must be met.

Eligibility for Benefits

• Residents of assisted living facilities have access to Medicare's home healthcare benefits. According to Medicare and "Home Health Care," a booklet published by the Centers for Medicare and Medicaid Services, you must be homebound, under a doctor's care, and using a Medicare-approved home healthcare aide or agency. You also must need only intermittent, or part-time, care. Your doctor must certify that the care you are receiving is necessary and develop a plan of care.

What Medicare Covers

• Medicare covers some part-time skilled nursing home care, even if your home is in an assisted living facility. Skilled nursing care is any care that must be supervised by a registered nurse or licensed practical nurse and can include starting an IV or tube feedings. You can also receive therapy, including physical or occupational therapy and speech-language pathology. As with any care received through Medicare, there are co-pays and deductibles, depending on the type of care received. Durable medical supplies are covered by original Medicare, up to 80 percent after the part B deductible. Medicare only covers home healthcare services it deems medically necessary, and even that is for a limited period of time, typically 60 days.

What Medicare Will Not Cover

• Medicare will not cover around-the-clock home care in an assisted living facility, cleaning, laundry, meal preparation, meal delivery or other homemaker services. Medicare does not cover personal care services, unless they are in conjunction with therapy or recovery, or the cost of room and board at an assisted living facility.

Other Payment Options

• There are other sources to look to for assistance with paying for home healthcare in an assisted living facility. Medicaid is a joint federal and state program that provides medical care, facility care and home healthcare for those with limited incomes. Apply for Medicaid through your state. State and county programs may also be of help; ask for the Department of Aging for information in your area.