We do not offer every plan available in your area. Currently we represent a small number of insurance agencies and the plans they carry. Please contact Medicare.gov, 1-800-MEDICARE (TTY 1-877-486-2048), 24 hours a day / 7 days a week, or your local State Health Insurance Assistance Program (SHIP) to get information on all of your options.
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The line that decides everything: medical care versus custodial care
Medicare, whether Original Medicare or Medicare Advantage, is built to pay for medical treatment, doctor visits, hospital stays and skilled rehabilitation. It is not built to pay for ongoing housing or for long-term help with daily living.
Assisted living
Room and board is not covered. No Medicare plan pays the monthly rent, meals or staffing fee at an assisted living community, a memory care residence or an independent living apartment.
Medical care delivered inside one is covered. If a visiting physician, physical therapist, nurse or hospice team treats your relative inside the community, those medical services are billed to Medicare Advantage the same as anywhere else.
Care at home
Skilled home health is covered when a doctor orders it and a Medicare-certified agency provides it: nursing, physical therapy, occupational therapy or speech therapy after an illness or hospital stay.
Non-medical help around the house is different. Bathing, dressing, cooking, laundry and overnight companionship are custodial care. Medicare does not pay for them on an ongoing basis.
A few plans add a limited extra. Some Medicare Advantage plans offer supplemental benefits aimed at people managing a chronic condition, which might include a set number of personal-care aide hours, safety items like grab bars, or a short run of delivered meals after a hospital discharge. These extras are limited, they usually require a qualifying diagnosis, and they do not replace day-to-day caregiving.
So how do families pay for the rest?
When round-the-clock help or an assisted living move is needed, families generally turn to:
- Savings and the family home. Proceeds from selling or downsizing a long-time house.
- State Medicaid programs, which fund custodial care for people who meet clinical and financial rules. These programs are state-run and have waiting lists.
- Veterans benefits, including the VA pension with Aid and Attendance for eligible wartime veterans and surviving spouses who need help with daily living.
- Long-term care insurance, if a policy was put in place before the need arose.
Working out which of these applies is exactly the kind of thing a care advisor can help with, and it is free to ask us.
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