Does Medicare pay for long-term care or does it pay for someone to live in an assisted living home? If not, what insurance pays for this type of care?
Medicare does not pay long-term care or assisted living facility care.
Because Medicare will pay for skilled care in a skilled nursing facility, many people mistakenly believe Medicare pays for long-term care.
There are strict rules as to when Medicare will pay for skilled care in a skilled nursing facility. To trigger the Medicare skilled nursing benefit, the client must have a qualifying inpatient hospital admission. The hospital stay must be for at least three consecutive days (not counting the day of discharge). The patient must require skilled services (such as physical therapy) and these skilled services must be reasonable and necessary for the client’s diagnosed condition. The skilled care must be ordered by a physician. The client must require the skilled care on a daily basis and such care can only be provided in an inpatient skilled nursing facility. The maximum that Medicare will pay for a skilled care, per benefit period, is 100 days.
For care in an assisted living facility or for long term-care in other settings, some people consider a Long Term Care insurance policy. The booklet, A Shopper’s Guide to Long-Term Care Insurance, explains this type of insurance. This booklet is published by the National Association of Insurance Commissioners (NAIC). You may request a copy by email at
or by calling 1-816-783-8300 or on-line at eapps.naic.org/forms/ipsd/Consumer_info.jsp.
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