The assisted living exemption provides in-home services for those who would need care in a nursing facility, including case management, personal care and. Although Medicare doesn't cover assisted living, you'll continue to pay for all services approved under Parts A and B, such as hospitalizations, doctor visits, procedures, and exams. Original Medicare Parts A and B don't cover assisted living or any other type of long-term care. However, it will cover the health services that your Medicare coverage normally covers if you're in an assisted living facility. Some services provided in an assisted living home may also be included in your Part A coverage.
Part A only covers long-term care if you need to stay in a skilled nursing facility or hospital, or if you need to receive occupational therapy, wound care or physical therapy after being discharged from that stay, usually for up to 100 days. You generally don't qualify for assisted living if you're bedridden or need memory care, major medical care, or ongoing supervision. Even if you can live alone, the National Institute on Aging recommends talking to friends and family to develop a long-term care plan for the future. To be eligible for assisted living in most states, you typically need daily assistance with at least two activities related to daily living.
Medicare and most health insurance, including Medicare Supplemental Insurance (Medigap), don't pay for long-term care services, including care in a nursing home or community. After an average stay of around 22 months, approximately 60% of residents will leave assisted living to transition to a skilled nursing facility. Eligible beneficiaries can reside in a home assisted living (PCH-AL) personal care facility that is authorized as such by the Mississippi State Department of Health and is approved as a Medicaid assisted living service provider. However, some (not all) Part C plans may cover certain non-medical services similar to those offered by assisted living centers, such as help with daily living activities, meal delivery, and transportation to and from medical appointments.
And while Medicaid doesn't pay for the room and board costs of assisted living, many states do offer exemption programs to help cover some personal care and other support services provided in an assisted living environment. Because it's not considered medically necessary, original Medicare (parts A and B) doesn't cover the costs of assisted living. People who live in assisted living facilities tend to be more independent than those who live in nursing homes, but they still receive 24-hour supervision and help with activities such as dressing or bathing. This refers to the non-medical help for everyday activities (such as eating and bathing) provided by most assisted living homes.
People with these qualities should consider turning to skilled nursing facilities or other facilities for their specific conditions and needs, which would not be treated in an assisted living facility. Residents of an assisted living facility generally don't need the type of ongoing care provided in a nursing home.
