Stamford Senior AdvisorDoes Medicare pay for assisted living or long-term nursing home care?
No: Medicare does not pay for assisted living rent or services, residential care homes, or long-term custodial care in a nursing home; it covers medical care, short skilled nursing facility stays after a qualifying hospital admission, home health visits and hospice.
That is the single most expensive misunderstanding families bring to a hospital discharge. A parent can be in a nursing home bed paid by Medicare one week and owe the full private rate the next, once skilled care is no longer needed.
How does Medicare's skilled nursing benefit work?
After an inpatient hospital stay of at least three days, Medicare Part A can cover up to 100 days of skilled nursing or rehab per benefit period: days 1 to 20 in full and days 21 to 100 with a daily coinsurance, but only while the patient needs and benefits from daily skilled care.
Time spent under hospital “observation” does not count toward the three days, so ask the hospital in writing whether your parent is an inpatient. Medicare Advantage plans may waive the three-day rule but can require prior authorization. In DPH's registry, Medicare (traditional plus Advantage) typically covers a minority of residents on any given day, reflecting how short these stays are.
What do Medicare home health and hospice cover?
Medicare home health covers part-time skilled nursing, therapy and aide visits for a homebound patient under a physician's plan, and Medicare hospice covers a comfort-care team, drugs and equipment for someone with a prognosis of six months or less, at home, in assisted living or in a nursing home.
Neither pays for hourly caregivers or for room and board. DPH's license export shows 27 home health care agencies with Fairfield County addresses, and CMS lists 7 Medicare-certified hospices with offices in the county. Ask any agency whether it is Medicare-certified for the services ordered.
Where can Fairfield County families get free Medicare counseling?
Connecticut's CHOICES program, the state's health insurance assistance program, gives free, unbiased Medicare counseling through the Area Agencies on Aging at 1-800-994-9422.
CHOICES counselors can compare Medicare Advantage and supplement plans, check drug coverage and screen for the Medicare Savings Programs, which help pay premiums for people with limited income.
At a glance
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Nursing homes | Short skilled stays after a qualifying hospital admission | Long-term custodial care |
| At home | Intermittent skilled home health | Hourly or live-in caregivers |
| Assisted living | Medical care a resident receives there | Rent, meals or assisted living services |
Sources include the Regulations of Connecticut State Agencies (19-13-D105 and related sections), the Connecticut General Statutes as summarized by the Office of Legislative Research, DPH, DSS and Aging and Disability Services pages, CareScout and VA rate tables as cited above; see our editorial standards.
