Are assisted living facilities covered by Medicare?

No, Medicare does not cover the cost of assisted living facilities or long-term custodial care. Here’s a breakdown of what Medicare does and doesn’t cover when it comes to assisted living:

🏠 What Medicare Does Not Cover:

• Room and board at assisted living facilities

• Help with activities of daily living (ADLs), like:

  • Bathing

  • Dressing

  • Eating

  • Using the bathroom

✅ What Medicare May Cover:

Medicare might cover some medical services provided to someone living in an assisted living facility, such as:

• Doctor visits

• Outpatient care

• Prescription medications (under Medicare Part D)

• Physical or occupational therapy (if medically necessary)

• Short-term skilled nursing care (after a qualifying hospital stay)

🧾 Who Pays for Assisted Living, Then?

Most people pay for assisted living using:

• Private funds (savings, retirement income, etc.)

• Long-term care insurance

• Medicaid (in some states, and only if you qualify based on income and assets)

• Veterans’ benefits (for eligible veterans or their spouses)

  Here’s a breakdown of how it works in Florida:

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  🏥 Medicare in Florida

  • Just like elsewhere, Medicare does not cover the cost of assisted living — i.e. room, board, and help with daily living (bathing, dressing, meals, supervision). Medicare.org+2AARP+2

  • Medicare may still pay for medical services while someone is in assisted living, such as:

    • Doctor visits, outpatient care, therapies

    • Medical equipment, etc.

    • Under certain circumstances, “home health” services (if qualified) even while in an assisted living facility SeniorLiving.org+2Florida Senior Consulting Advisors+2

  • If someone needs skilled care (after a hospital stay), Medicare can cover stays in a Skilled Nursing Facility (SNF) for a limited time — but that is separate from assisted living. AARP+2NerdWallet+2

  So in short: Medicare won’t cover the assisted living “living costs” in Florida either.

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  💡 Medicaid & Other Florida Programs

  While Medicare doesn’t help with assisted living, Florida does offer some Medicaid‑based help (with restrictions):

  • Assistive Care Services (ACS) under Florida Medicaid
    Florida Medicaid offers Assistive Care Services for people residing in licensed assisted living facilities (ALFs) (and certain other residential care settings). These services can include help with daily living tasks, medication assistance, etc. Florida Health Care Admin+1
    However, Medicaid does not cover room and board (housing, meals, utilities) in ALFs via this program. Medicaid Long Term Care+2Accounting Insights+2

  • Statewide Medicaid Managed Care – Long-Term Care (SMMC‑LTC)
    Florida’s SMMC LTC program provides Medicaid long-term care benefits, which can include services delivered in assisted living, adult family care homes, or in the home. But again, the cost of room and board is excluded. Paying for Senior Care+3Medicaid Long Term Care+3Nolo+3
    To be eligible, a person typically must qualify for “nursing home level of care” (i.e. showing a need for substantial assistance) and meet income and asset limits. Nolo+2Medicaid Long Term Care+2

  • Optional State Supplementation (OSS)
    Florida has a program called OSS that can help low-income individuals with the cost of room and board in ALFs or adult family care homes, supplementing other benefits. Nolo+1

  • PACE (Program of All-Inclusive Care for the Elderly)
    Florida offers PACE in many areas. It’s a program that coordinates medical, social, and long-term care services for people who qualify (often dual-eligible for Medicare and Medicaid). In some cases, PACE can coordinate services in or to assisted living settings. AssistedLiving.org+1