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Does Medicare Supplement Insurance Cover Assisted Living Care?

When it comes to Medicare Supplement insurance — also called Medigap plans — it’s common to have questions about specific types of coverage. Here on the Awaring America blog, we try to answer those questions so you can make more informed decisions about your healthcare needs.

A common question concerns assisted living care. Many people aren’t sure exactly what assisted living is or how it’s different from other types of care. We’re going to answer those questions and more today.

What Is Medicare Supplement Insurance?

Medicare Supplement insurance is private insurance you buy through an insurance carrier in your area. There are 10 Medigap plans available, each of which offers different types of coverage for out-of-pocket expenses like coinsurance, copayments, and deductibles.

You can choose from Medigap Plans A, B, C, D, F, G,K, L, M, and N. Don’t confuse Medigap Plans A, B, C, and D with Original Medicare Parts A, B, C, and D. They’re completely different things.

To qualify for Medicare Supplement insurance, you must have Original Medicare Part B. You can then apply for the plan you want based on the quotes you get from individual insurance companies.

What Is Assisted Living Care?

Woman in assisted living

Assisted living describes a residential community wherein older adults receive help from skilled providers with tasks like dressing, bathing, eating, taking medication, going to appointments, and more. They offer considerable freedom, often providing residents with private apartments and plenty of privacy, but they also emphasize socializing.

It’s different from senior living communities in that assisted living care provides more services. For instance, residents might not be able to bathe on their own. In a senior community, residents live much like people who live in regular apartment communities.

How Does an Assisted Living Facility Differ From Skilled Nursing Care?

Many people confuse skilled nursing care and assisted living care. They’re not the same thing.

Skilled nursing care is another level of service that provides residents with more medical services. People who live in nursing homes and other skilled nursing facilities might not be able to live in their own apartments or take care of themselves properly. They need regular monitoring for serious health conditions.

Assisted living falls between skilled nursing care, which provides more assistance and less freedom, and senior living, which provides far fewer services but more freedom.

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Do Any Medigap Plans Cover Assisted Living?

Medicare Supplement insurance does not provide coverage for assisted living care. It only covers short-term care in facilities like nursing homes or short-term at-home care.

Medigap can cover certain expenses you might incur while living in an assisted living facility. For instance, if you need durable medical equipment, such as a CPAP machine for respiratory assistance, those costs will be covered at least in part by Medicare Supplement insurance.

Your Medicare Supplement insurance will also cover any other healthcare costs covered by your individual plan, such as the first three pints of blood every year or visits from your physician.

However, Medicare won’t cover the costs associated with living in the facility. Assisted living care usually involves costs related to food, board, and other services.

What Are Assisted Living Coinsurance Costs, Deductibles, Copayments and Other Assisted Living Costs?

As mentioned above, your Medicare Supplement insurance plan might cover certain costs related to medical care at an assisted living facility. The out-of-pocket costs you’ll owe will depend on your plan.

For instance, Medigap Plan F covers your Part B deductible. This means that you won’t have to pay out-of-pocket for physician care. You might go to the doctor while you’re living in an assisted facility, so you’ll want to consider healthcare costs you might incur.

Similarly, if you need medical assistance at the care facility, your Medicare Supplement insurance might cover part or all of your expenses. Coinsurance payments are expenses you owe out-of-pocket as a percentage of the total cost of care, while copayments are the fixed fees you pay at the time of healthcare service.

Patient being pushed in wheelchair by nurse in assisted living

Since assisted living facilities don’t provide high-level medical care, your expenses will mostly relate to personal services, room, and board.

How Can You Prepare Financially For Assisted Living Care?

It can be expensive to live in an assisted living facility. In Texas, for instance, the average cost per month for such facilities is over $3,500 per month. If Medicare Supplement insurance doesn’t cover those costs, how can you afford it?

If you have long-term care insurance, your costs can be reduced or eliminated. This is a separate insurance policy that you take out to cover the costs related to long-term assisted living and similar facilities.

This is why it’s essential to plan for your future when it comes to healthcare. A Medicare Supplement insurance policy is important, but so is planning for other eventualities.

Not Sure Where to Start? Here is a List of Questions you can Ask to Get the Conversation Going

  • What are the costs associated with assisted living facilities and does Medicare cover these costs?
  • How do Medicare Advantage plans factor into the coverage for an assisted living cost?
  • Does Medicare cover the cost of skilled nursing care in an assisted living facility?
  • How is the federal health insurance program involved in covering costs for assisted living communities?
  • To what extent does Medicare cover assisted living services provided by facilities?
  • What part of the cost for a skilled nursing facility is covered by Medicare?
  • Does Medicare cover all or part of the costs associated with assisted living?
  • What specific medical services in an assisted living community does Medicare cover?
  • How does personal care in an assisted living community factor into what Medicare will cover?
  • Does Medicare cover the costs of transitioning from a nursing home to an assisted living facility?
  • How much of the daily living assistance provided by an assisted living facility is covered by Medicare?
  • Does Medicare pay directly to the assisted living facility or do I have to pay upfront and get reimbursed?
  • How do Medicaid services coordinate with Medicare when covering assisted living costs?
  • Does my hospital insurance through Medicare contribute to covering assisted living costs?
  • What are the assisted living benefits that Medicare covers?
  • Does Medicare cover the costs of hospice care within an assisted living facility?
  • How do private insurance companies work with Medicare in terms of covering assisted living costs?
  • What aspects of respite care in an assisted living facility does Medicare cover?
  • Does Medicare coverage extend to inpatient hospital care received while living in an assisted living community?
  • How does Medicaid coverage overlap with or supplement Medicare coverage for assisted living?

Learn More About Medicare Coverage for Assisted Living

Knowing that Medicare Supplement insurance won’t cover assisted living can help you prepare financially for your future in retirement. You might want to consider long-term care insurance to help protect yourself in case you need to move into an assisted living facility.

While Medigap plans do not cover assisted living, some do cover short-term skilled nursing care. This includes nursing homes and in-home care, but keep in mind that Medicare limits the amount of time you can receive those benefits.

If you’re interested in applying for Medicare supplement insurance, Ensurem’s Medigap Quoter can help. Decide which plan or plans you’re interested in and fill in your personal information, including your date of birth, gender, and tobacco use. In under a minute, Ensurem will generate a list of quotes that you can compare.

Since Medigap plans are standardized, you don’t have to worry about comparing coverage between plans of the same letter. For instance, Plan A from Insurance company Y is the same as Plan A from Insurance Company Z. The premiums can vary, though, which makes comparison shopping essential.

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Education is crucial in finding the right Medicare solution for you. With so many Medicare resources out there, it can be difficult finding a source you can trust. That’s why Ensurem has a Compliance Program dedicated to ensuring our Medicare content meets Centers for Medicare & Medicaid Services (CMS) regulations. So, you can rest assured you’re getting the information you need to make the right coverage decisions.

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Denise Austin, 65, Ensurem Ambassador

Best-Selling Author, Creator of Fit Over 50 Magazine

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