Medicare Benefits in Senior Care Facilities - The Caring Chronicles | Senior Caring Blog

Medicare Benefits in Senior Care Facilities

Understanding the ins and outs of Medicare isn’t always easy. Once you’ve reached the stage in your life to choose a specific type of care, it’s important to understand all of the Medicare benefits available to you. Most seniors are covered under the Original Medicare Plan, which requires payment for some health care in addition to monthly payments for doctors, hospital care, and prescriptions. The advantages to Medicare can be more than what just listed in the typical breakdown of Medicare benefits.

Medicare Benefits for Senior Living

For a large portion of seniors, Medicare is the main source of insurance coverage. While it does not provide long-term care for medical issues, there are benefits for seniors on a short-term basis. This can actually be helpful when you are living in a senior care facility.

When you find the senior care option that’s best for you, if you have Medicare, make sure you understand how you are covered in your care option. Not all senior care facilities accept full Medicare coverage or offer full Medicare benefits.

Understanding Medicare Benefits in Senior Care Facilities

Nursing Facility

Medicare will reach a limit of a full 20 days in a nursing facility. This means 100% of the cost of those first 20 days is covered. The next 80 days in that facility is covered at 80%. For medicare benefits to cover these costs, the care provided must follow a hospital stay requiring recovery.

Assisted Living

While Medicare does not offer coverage of living costs in an assisted living community, it will still cover any medical costs sustained during your stay. It will not cover any custodial care or contribute to the cost of room and boarding fees.

At-Home Care

If a senior receiving at-home care is defined as “confined” to the house, meaning they cannot leave home without another person, Medicare will cover the cost; but this is only true for non-medical care. It will also only cover the cost of nursing care in the home for a short time period. All types of care must be pre-approved by a physician and are only offered as part-time care.

Adult Day Care

Unfortunately, Medicare benefits do not cover adult day care services.

Alzheimer’s & Dementia

Medicare will not pay for most types of care relating to Alzheimer’s or Dementia as it is considered “personal care.” However, any type of medical care associated with these diseases is covered. If a patient is in the last stages of Alzheimer’s, Medicare has a hospice benefit that may be applicable to beneficiaries of the plan.


Terminally ill patients with 6 months or less to live are given hospice coverage under Medicare. Medicare hospice will cover the medical fees and prescription medication, but it will not cover room and board.

Author: scadmin

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