Rochester Senior AdvisorDoes Medicare pay for assisted living or long-term nursing home care?
No; Medicare does not pay for assisted living, adult home or enriched housing rent, or for long-term custodial care in a nursing home, which is help with bathing, dressing and similar daily needs rather than skilled care.
That gap is the reason New York families end up paying privately, using long-term care insurance or VA benefits, or applying for Medicaid. Medicare Advantage plans do not close it either, though some offer small supplemental benefits.
When does Medicare pay for a nursing home stay?
Original Medicare pays for up to 100 days of skilled nursing facility care per benefit period after a qualifying inpatient hospital stay of at least three days, in full for days 1 to 20 and with a daily coinsurance for days 21 to 100, as long as skilled care is still needed.
Time spent under observation status in the hospital does not count toward the three days, so ask whether a parent is formally admitted. Medicare Advantage plans set their own rules and often require prior authorization for a rehab stay.
Does Medicare pay for home health care?
Yes; Medicare pays in full for part-time skilled nursing, therapy and home health aide visits for a homebound patient under a doctor's plan of care, provided by a Medicare-certified home health agency.
It does not pay for hourly companions or round-the-clock aides. Certified home health agencies with Rochester-area offices include UR Medicine Home Care, Rochester Regional Health Home Care and HCR Home Care.
Does Medicare pay for hospice?
Yes; Medicare's hospice benefit pays for the hospice team, medications for comfort, equipment and supplies for a patient whose doctor certifies a life expectancy of six months or less, at home, in assisted living or in a nursing home.
It does not pay room and board in a residence or nursing home. A patient can leave hospice and return later, and hospice can continue past six months if the doctor recertifies.
Where can Rochester seniors get free Medicare counseling?
The Health Insurance Information, Counseling and Assistance Program (HIICAP) gives free, unbiased Medicare counseling; in Monroe County it is reached at (585) 287-6413, and the other four counties' Offices for the Aging run their own HIICAP counselors.
HIICAP counselors can compare Medicare Advantage and Medigap options, explain the Medicare Savings Programs and New York's EPIC prescription program (participant helpline 1-800-332-3742), and help with appeals.
At a glance
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Nursing homes | Up to 100 skilled days after a qualifying stay | Long-term custodial care |
| At home | Part-time skilled home health | Hourly or live-in aides |
| Hospice | Team, comfort drugs, equipment | Room and board |
| Assisted living | Doctor visits and skilled care delivered there | The rent |
Sources include the N.Y. Social Services Law and Public Health Law, 18 NYCRR Parts 487-494, 10 NYCRR Parts 415 and 1001, Department of Health GIS messages, CMS, the VA and CareScout, as cited above; see our editorial standards.
