Does Medicare Cover Assisted Living, Hospice, In-Home, Or Nursing Care?

If you are concerned about whether Medicare covers important services like:

  • assisted living
  • hospice 
  • in-home care
  • or nursing care

In this article, we'll tell you whether or not Medicare covers it, and if it doesn't, the best way to get it covered using a Medicare Supplement or Long-term care insurance plan.

Important: Our most commonly requested item is if Medicare covers assisted living, which we discuss in detail below, but the short answer is "no."  Search for the best rates on Long-term care and Medicare Supplement insurance to make sure you can pay for assisted living.

There is a lot of confusion about whether Medicare covers assisted living and other senior care facilities. 

The reason for the confusion depends on whether the care given is classified as custodial or medically necessary. 

Medicare does not cover custodial care which includes your residential living costs like rent, food, and entertainment.

We will discuss in this article the difference between the two categories and how it affects coverage for assisted living, hospice, in-home, or nursing care.

Does Medicare CoverAssisted Living, Hospice, In-Home, Or Nursing Care

Does Medicare Cover Assisted Living? 

Medicare does not cover the costs of assisted living facilities. 

You might consider looking into a Medicare Supplement or Long-Term Care plan to meet the needs not covered by Medicare.  Get a quote using the state-by-state form below.

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Your Medicare insurance is there to help cover your hospital and doctor’s visits, but in most cases, Medicare won’t cover custodial care. 

Custodial care includes things that would be considered room and board. 

These would include rent, food, personal items, clothes, and entertainment.

In some states, Medicaid is available to help cover Seniors living costs and custodial care. 

Most people pay for assisted living facilities by selling their house or using funds they have saved in the bank. 

Some assisted living facilities will accept a combination of your social security and state benefits to cover your monthly expenses.

Does Medicare Cover Hospice?

When a loved one is nearing the end of their life, rest assured, Medicare will cover hospice care. 

Hospice programs are designed to support the terminally ill, not to cure the disease but to make the person more comfortable, which is commonly referred to as palliative care. 

The Medicare hospice services covered are quite extensive, with little to no cost to the patient or their family. 

To qualify the patient must:

  • Qualify for Medicare Part A
  • Doctor certified that they are terminally ill
  • Less than six months to live

Hospice services included are drugs for pain relief and symptom management; medical, nursing, and social services.

However, Medicare does not cover hospice room or board as that is considered custodial care.

Most patients receive their hospice care at home, surrounded by their families and loved ones. 

While many may think of hospice care as only pain relief and symptom management, there are actually multiple services available to the patient and their family. 

  • Doctor services
  • Nursing care
  • Durable medical equipment (such as wheelchairs or walkers)
  • Medical supplies (such as bandages and catheters)
  • Prescription drugs for symptom control or pain relief
  • Nutritional/dietary counseling
  • Hospice aide and homemaker services
  • Physical and occupational therapy services
  • Social work services
  • Grief and loss counseling for both the patient and their family
  • Short-term inpatient care for pain and symptom management
  • Short-term inpatient respite care
  • Any other Medicare-covered services recommended by the hospice team

Medicare will cover temporary inpatient services related to respite care for the patient's primary caregivers.

Does Medicare Cover In-Home Nursing Care?

There is a wide range of home health care services covered by Medicare. 

Some of these services included skilled nursing care, therapy, and care by home health aides. 

However, home health care is only covered by Medicare if:

  • Your doctor has certified you as homebound
  • You need skilled nursing service or therapy care on an intermittent basis 
  • You have a face to face meeting with your doctor 90 days before starting home health care or within 30 days of starting
  • Your doctor signs a home health certification declaring you homebound or in need of intermittent services
  • And, you receive care from a Medicare-certified home health agency
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Does Medicare Cover Physical, Occupational, And Speech Therapy? 

Medicare will pay for physical therapy and occupational therapy if the patient is expected to improve in a planned and predictable time frame. 

They will not pay for therapy that is experimental or does not make measurable gains. 

These services are commonly provided after an injury or illness that has reduced the patient's strength or functionality. 

Some services can be offered at home if you qualify or at medical facilities near your home.

Does Medicare Cover Durable Medical Equipment? 

Medicare will cover medically necessary equipment that your doctor prescribes for home use. 

Durable medical equipment is a doctor prescribed equipment that is medically necessary due to a patient's illness or an injury. 

The most common DME prescribed are:

  • Canes
  • ​Walkers
  • ​Wheelchairs
  • Blood sugar monitors
  • Oxygen
  • Hospital beds

Does Medicare Cover Skill Nursing Facilities? 

Skilled nursing facilities are covered by Medicare Part A for up to 100 days, at which point you are responsible for all of the costs. 

One option you may consider is a Medicare Supplement plan or long term care insurance plan to cover the costs that Original Medicare does not.

To qualify for a skilled nursing facility, you must meet the following requirements:

  • You have Original Medicare Part A with days left in your benefit period
  • Your condition qualifies for Medicare coverage
  • Your doctor prescribed daily skilled care. 
  • You have a hospital-related medical condition (untreatable at home)
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Take Action!  

As you can tell, it really depends on the specific situation to know if Medicare will cover you. 

Senior Benefits have 50 years of experience helping seniors figure things like this out. 

There are also many instances where a Medigap plan could help save you money. 

Give a Senior Benefits Medicare expert a call today to find out ALL of your options.