Does Medicare Pay for Assisted Living in Florida?

In this article

1. What Medicare does not cover
2. What Medicare still covers while your parent lives here
3. The one place Medicare does pay for a facility stay
4. Medicare and Medicaid are not the same program
5. What actually pays for assisted living in Florida
6. The short version for a family deciding this week

No. Medicare does not pay for assisted living in Florida. It does not cover the room, the meals, or the help with bathing, dressing, and medications that make up most of an assisted living bill. Medicare calls that custodial care, and its own coverage page says plainly that you pay all costs for it.

That surprises most families, because Medicare covers so much else. The useful way to think about it: Medicare pays for medical care wherever your parent lives. It does not pay for the living part.

What Medicare does not cover

Medicare treats assisted living as long term care, which it also calls custodial care. Its coverage page lists exactly what that means: help with personal care like dressing, bathing, and using the bathroom, plus things like home delivered meals and adult day health care.

Medicare says you can receive that kind of care at home, in the community, in an assisted living facility, or in a nursing home, and that it does not pay for any of it. Medicare supplement insurance, also called Medigap, does not fill this gap either, because Medigap only helps with costs Medicare already covers.

So the monthly assisted living fee, the part that covers a private room, three meals a day, and a caregiver helping your mother get dressed, is not a Medicare expense. It is paid privately, through long term care insurance, through veterans benefits, or through Medicaid.

What Medicare still covers while your parent lives here

This is the part families miss, and it matters. Moving into assisted living does not change your parent's Medicare at all. They keep every benefit they had at home:

• Doctor visits, specialists, lab work, and preventive care under Part B
• Hospital stays under Part A
• Prescriptions under their Part D plan
• Medicare certified home health, when a doctor orders it and they qualify
• Hospice care, when it is time
• Durable medical equipment like a walker, a wheelchair, or oxygen

A resident here can see their own doctor, use their own pharmacy plan, and have a home health nurse or a physical therapist come to the community. Medicare pays for those the same way it did before the move.

The one place Medicare does pay for a facility stay

Medicare Part A covers skilled nursing facility care, which is different from assisted living. Skilled care is nursing or therapy that has to be delivered by trained professionals, usually while someone recovers from a hospitalization.

To qualify, Medicare requires all of the following:

• A qualifying inpatient hospital stay of at least three days in a row
• Entry into the skilled nursing facility within a short window after leaving the hospital, generally 30 days
• A doctor's determination that daily skilled nursing or therapy is needed
• Care delivered in a Medicare certified skilled nursing facility

Coverage is capped at 100 days per benefit period. Days 1 through 20 are covered in full once the deductible is met, days 21 through 100 carry a daily coinsurance, and after day 100 the resident pays everything. Most people do not use anywhere near the full 100 days.

When that skilled stay ends, families often discover the real question underneath: your parent has recovered enough to leave rehab, but not enough to go home alone. That is the moment assisted living usually enters the picture, and the moment Medicare stops helping with the bill.

Medicare and Medicaid are not the same program

The two names sound alike and get used interchangeably in conversation, which causes real confusion. They are separate programs with opposite roles in this decision.

If you are trying to work out how to afford a move, Medicaid is the program to look at, not Medicare. We wrote a fuller explanation of how Florida Medicaid pays for assisted living, and a plain guide to the Medicaid long term care program itself.

What actually pays for assisted living in Florida

In practice, families here use some combination of four things:

1. Private funds. Savings, a pension, Social Security, or the proceeds from selling a house.
2. Florida Medicaid. For families who qualify financially, the state's long term care program can cover assisted living services. Both Sugarmill Manor and The Gardens accept Florida Medicaid, which is not true of every community in the county.
3. Veterans benefits. The VA Aid and Attendance benefit adds to a monthly pension for veterans and surviving spouses who need help with daily activities.
4. Long term care insurance. If a policy was bought years ago, now is the time to read it. Most policies pay a daily benefit for assisted living once someone needs help with a set number of daily activities.

There is also Optional State Supplementation, a Florida payment that helps some low income residents in licensed assisted living. Ask an administrator whether it applies to your situation.

The short version for a family deciding this week

Do not wait for Medicare to cover the move, because it will not. Instead, get three answers: what your parent's monthly income and assets actually are, whether a long term care policy exists in a drawer somewhere, and whether the veteran in the family ever served during a qualifying period.

Then call a community and ask directly what a month looks like for someone with your parent's needs, and whether they accept Medicaid. A real number from a real administrator beats a range from a directory site every time.

Frequently asked questions

Does Medicare pay for assisted living in Florida?

No. Medicare does not pay for assisted living room, board, or personal care. Medicare classifies that as long term custodial care and states that you pay all costs for it. Medicare still covers your parent's doctor visits, hospital care, and prescriptions while they live in assisted living.

What does Medicare cover if my parent lives in assisted living?

Everything medical that it covered before the move: Part B doctor visits and preventive care, Part A hospital stays, Part D prescriptions, Medicare certified home health when a doctor orders it, hospice, and durable medical equipment such as a walker or oxygen. Moving into assisted living does not change your parent's Medicare coverage.

How long does Medicare pay for rehab in a skilled nursing facility?

Up to 100 days per benefit period, and only after a qualifying inpatient hospital stay of at least three days in a row. Days 1 through 20 are covered in full once the deductible is met, days 21 through 100 carry a daily coinsurance, and after day 100 the resident pays everything. Time under observation status does not count toward the three day requirement.

What is the difference between Medicare and Medicaid for assisted living?

Medicare is health insurance for people 65 and older and does not pay for assisted living. Florida Medicaid is a needs based program that can cover assisted living services for families who qualify financially. Medicaid is the program to look at when you are working out how to afford a move. Both Sugarmill Manor and The Gardens accept Florida Medicaid.

Does Medicare Advantage pay for assisted living?

No Medicare Advantage plan covers assisted living room and board. Some plans add extras such as transportation, an allowance for over the counter items, or limited in home support. If a plan advertises something that sounds like it covers assisted living, call the plan and ask specifically whether it pays the monthly residency fee.

Sources

• Medicare.gov, Long term care coverage
• Medicare.gov, Skilled nursing facility care
• Florida Statewide Medicaid Managed Care
• Florida DCF, Public assistance
• VA Aid and Attendance

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Written by

Cameron Hernando Clark

Community Relations Director

Cameron Hernando Clark is the Community Relations Director for The Manors of Citrus. He writes this family guide to help Citrus County families make sense of assisted living and memory care, drawing on the day to day of running two family owned communities on Florida's Nature Coast.