Medicare Assisted Living: What’s Covered and What’s Not

12.16.2025 | Category: Medicare

A woman sitting on a couch in a sunny sitting room in an assisted living facility speaking with a nurse.
Estimated read time: ~10 minutes

Summary: For many older adults, assisted living becomes necessary when everyday tasks and personal care are no longer manageable without help. While the decision is often driven by health and safety concerns, it’s also wise to consider the financial requirements of assisted living and if Medicare may help with the costs.

There are plenty of common misconceptions about costs and insurance support, though, and your first question may be: Will Medicare pay for assisted living?

What is assisted living?

Assisted living is a term for residential facilities that provide services geared toward older individuals and those with disabilities who may struggle with household chores and tasks. While assisted living facilities may offer apartments, meals and activities, their primary role is providing essential support with activities of daily living for those who can no longer safely live alone. Additional help for tasks that become more challenging as we age, such as bathing, dressing and housekeeping, is also available.

In assisted living, these tasks are referred to as activities of daily living (ADLs). In many assisted living facilities, residents pay a fee for room and board and may incur an additional charge based on their acuity, which measures the level of assistance they require with ADLs.

Assisted living differs from a nursing facility. Assisted living offers some support, such as medication reminders or help getting into a wheelchair, but it’s designed for people who can still live semi-independently. Aging individuals requiring access to medical care 24/7 should consider a nursing home instead of assisted living.

Will Medicare pay for assisted living?

No, Medicare does not pay for assisted living. Medicare is a health insurance plan that covers healthcare-related expenses. It doesn’t include living costs, including assisted living fees.

For assisted living, you’ll typically have to pay from other sources. It’s worth noting that you may be able to get some covered Medicare services while in assisted living, such as visits from a home health aide or doctor-prescribed medical devices.¹ If you want insurance that helps with assisted living, long-term care insurance may be beneficial.

Why assisted living is generally not covered by Medicare

Assisted living is generally not covered by Medicare because it’s classified as custodial care, not medical care. According to the Centers for Medicare & Medicaid Services (CMS), custodial care includes help with daily activities like bathing, dressing, eating and using the bathroom, which are not considered medically necessary services.²

Medicare covers only skilled nursing or medical care that is necessary to treat or manage a health condition, such as physical therapy or wound care after surgery. Since most assisted living support focuses on daily living needs (ADLs) rather than direct medical treatment, it falls outside the scope of Medicare coverage.

Services Medicare might cover in an assisted living setting

Medicare doesn’t cover room, meals or personal care in assisted living facilities, but it may help with certain medical services provided within these facilities, depending on your coverage plan.

Original Medicare typically covers specific services under Part A (hospital-related) and Part B (outpatient care), while Medicare Advantage plans may offer additional benefits, such as dental, vision or in-home support services.

Examples of medical coverage you may get from Medicare while living in an assisted living community include:

Medical checkups and doctor visits
Outpatient therapies (physical, occupational, speech)
Skilled nursing care (short-term and medically necessary)
Certain prescriptions (via Medicare Part D or Medicare Advantage plans)
Lab work and imaging (like blood tests or X-rays)
Durable medical equipment (e.g., walkers, wheelchairs)
Hospice care
Home health services if medically required, and you qualify

Medicare Advantage plans and assisted living coverage

Medicare Advantage plans, also known as Medicare Part C, are offered by private insurers and include everything Original Medicare covers, and often more. While they still don’t pay for room and board in assisted living, some Medicare Advantage plans may offer limited supplemental benefits that can help with specific non-medical needs within an assisted living setting.

Every plan is different, but potential benefits may include:

Transportation to medical appointments
Meal delivery
Limited in-home support services (e.g., help with daily tasks)
Wellness programs or care coordination
Coverage for prescription drugs (often included in Medicare Advantage plans)

If you’re shopping for a Medicare Advantage plan, be sure to ask about these and other additional benefits you may want in the future.

Tips for planning and budgeting for assisted living

The cost of assisted living varies widely by location, level of care and facility operators. As a reference point, an average assisted living facility costs around $4,500 per month.³

Start with a cost estimate: Research assisted living costs in your area to set a realistic monthly budget. These expenses can often arise suddenly when one’s health changes.
Understand what’s included: Check out multiple facilities, and ask for a breakdown of what the base price covers (such as meals and housing) and what services come with extra fees, like medication management or personal care.
Factor in future care needs: Choose a facility that can offer additional care as needs change, so you won’t have to relocate if medical conditions worsen.
Explore financial assistance options: Medicaid waivers, Department of Veterans Affairs (VA) Aid and Attendance or long-term care insurance may reduce your out-of-pocket costs.
Create a dedicated care fund: Set aside money specifically for long-term care, potentially using a Health Savings Account (HSA) or an investment account, depending on your timeline.
Consider downsizing or selling assets: Selling a home, second vehicle or other valuable assets can provide cash in the short term and lower ongoing maintenance costs to help fund care and monthly living expenses.
Engage a financial planner or elder law attorney: These professionals can guide you through benefit eligibility, tax strategies and asset protection planning. Missteps can affect eligibility for Medicaid or other critical benefits needed for care, so the added cost may be worthwhile to some individuals.
Review Medicare and insurance plans: While Medicare won’t cover room and board, it may reduce medical expenses through coverage for doctor visits, therapies and prescriptions.

Making assisted living more affordable

Paying thousands of dollars per month for assisted living can be a significant financial challenge. While there is no standard Medicare assisted living coverage, Medicare can play an essential role in keeping other medical costs low, which can free up funds for assisted living and other needs.

Additionally, different types of insurance coverage, including Medicare supplement plans, Medicare Advantage and long-term care plans can help keep out of pocket costs stable and predictable over time.

Visit our Medicare Advice Center if you have questions or want help evaluating options.

FAQs on Medicare for assisted living

Q1. Does Medicare cover home health care?

Medicare covers home health care services like skilled nursing, physical therapy and limited home health aide support, but only if you’re homebound and your doctor certifies that the care is medically necessary.

Q2. What assisted living services are covered by Medicare?

Medicare does not cover assisted living costs, such as rent or personal care, but it may help cover medical services provided within the facility, including doctor visits, therapies and durable medical equipment.

Q3. Does Medicaid cover assisted living?

In many states, Medicaid can help cover the costs of assisted living through waiver programs. However, coverage varies and is typically limited to specific facilities and individuals who meet certain income and care requirements.⁴

Q4. Does Medicare cover adult day care?

Medicare generally does not cover adult day care services, though some Medicare Advantage plans may offer limited coverage as an added benefit.

Q5. Will Medicare pay for a nursing home?

Medicare pays for short-term stays in a skilled nursing facility if medically necessary and following a qualifying hospital stay, but it does not cover long-term care in a nursing home.