Last updated 2026-07-23
TL;DR
No. Medicare doesn't cover the room, board, or personal care costs of assisted living, because that's considered custodial care, not medical care. Medicare will still pay for doctor visits, therapy, and some home health or hospice services delivered to someone living in an assisted living facility. Medicaid, through state Home and Community-Based Services waivers, sometimes helps with the service portion of the bill, but rarely covers rent.
Does Medicare cover assisted living facilities?
Straight answer: no. Medicare, whether Original Medicare or a Medicare Advantage plan, does not pay for the monthly cost of living in an assisted living facility. It won't cover the rent, the meals, the housekeeping, or the help with bathing and dressing that makes up most of what a resident actually pays for. Medicare.gov puts it plainly on its long-term care page: "Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need" [1]. Custodial care is the government's term for help with everyday activities like eating, dressing, and using the bathroom, which is exactly what most assisted living residents are paying for. That said, Medicare isn't totally absent from the picture. If a resident of an assisted living facility qualifies for Medicare-covered services, like a doctor's visit, physical therapy, or a piece of durable medical equipment, Medicare Part B still pays for those the same way it would if the person lived at home. The facility itself just isn't a covered benefit. Some Medicare Advantage plans now offer limited supplemental extras, like meal delivery after a hospital stay, transportation, or in-home support services, under expanded benefit rules CMS finalized starting with the 2019 and 2020 plan years. These are narrow, plan-specific add-ons, not a substitute for paying an assisted living bill, and not every plan offers them. Confirm what's actually in a plan's Evidence of Coverage before counting on anything.
What does Medicare actually pay for in a facility setting?
| Room and board in assisted living | No | Considered custodial care [1] | |
|---|---|---|---|
| Personal care help (bathing, dressing) | No | Custodial, not medical | |
| Doctor visits, Part B services | Yes | Same as anywhere else | |
| Physical/occupational therapy | Yes, if medically necessary | Requires a plan of care | |
| Skilled nursing facility stay | Yes, up to 100 days per benefit period | Requires a qualifying 3-day inpatient hospital stay first [2] | |
| Hospice care | Yes for hospice services | Room and board in the facility is not covered even during hospice [3] | |
| Home health nursing visits | Sometimes | Person must meet homebound and skilled-need criteria | On the skilled nursing facility (SNF) benefit specifically: Medicare Part A covers the first 20 days in full after a qualifying hospital stay, then requires daily coinsurance from day 21 through day 100. That coinsurance changes every year; CMS set it around $204 a day in 2024 [2]. After day 100, Medicare pays nothing more for that benefit period. And critically, a skilled nursing facility is a different license category than assisted living. This benefit doesn't extend to a standard assisted living building even if a nurse visits regularly. |
Medicare pays for medical care, wherever the person happens to be living. It does not pay for the setting itself. Here's the split people usually get confused about. | Service | Covered by Medicare? | Notes |
What is assisted living?
Assisted living is a residential setting where people who need some help with daily living, but not full nursing care, get housing, meals, and personal care support in one place. Think help with bathing, dressing, medication reminders, and meals, plus social activities and 24-hour staff availability. Assisted living is licensed at the state level, not the federal level, which is a big reason coverage and terminology vary so much from state to state. There's no single federal "assisted living" statute. Instead, each state's licensing agency defines what the term means, what staffing ratios apply, and what level of care a facility is allowed to provide. The assisted living category sits between independent living (basically an apartment with some amenities) and a nursing home (24-hour skilled medical care). The national trade association for this sector, AHCA/NCAL, tracks state-by-state data and definitions and is a useful starting reference when a term isn't matching what you expected [4]. If you're comparing options or researching assisted living facilities in a specific area, expect real differences in what's included from state to state and even building to building.
What is an assisted living facility, and how is that different from a group home?
An assisted living facility is the physical building and the licensed operation providing housing plus personal care services, usually to a larger group, often 20 to 100+ residents, with dedicated dining rooms, activity spaces, and larger staff teams. A group home is typically smaller, often somewhere in the range of 4 to 16 residents depending on the state and license type, operating out of a converted single-family house or small purpose-built residence. Group homes serve a wider range of populations than most people assume. Some serve seniors. Others serve adults with intellectual or developmental disabilities, people in mental health recovery, or people in substance use recovery. The license category, the state agency overseeing it, and the required staffing all shift based on which population the home serves, so the first real decision an operator makes isn't paperwork, it's population. Because group homes are smaller, they're often licensed under a different chapter of state law than large assisted living facilities, sometimes with lighter staffing requirements but tighter limits on resident count and building size. Confirm with your state licensing agency which category your planned home falls into before you sign a lease or buy property, because zoning and licensing categories are tied together in most states.
What's the difference between assisted living and a nursing home?
| Level of care | Personal care, non-medical | Skilled nursing, medical | |
|---|---|---|---|
| Staffing | Aides, med techs, some nursing oversight | Licensed nurses on-site 24/7 | |
| Typical Medicare coverage | None for room/board | Up to 100 days after qualifying hospital stay [2] | |
| Typical resident profile | Mobile or semi-mobile, needs help with ADLs | Needs ongoing medical monitoring | |
| Regulatory body | State assisted living/residential care licensing agency | State health department, plus federal Medicare/Medicaid certification for SNFs | A lot of families end up moving a loved one from assisted living to a nursing home once medical needs increase past what non-medical staff can legally provide. That's a licensing line, not a preference. Staff at a licensed assisted living home generally cannot administer certain medical treatments that a nursing facility's licensed nurses can. |
The short version: assisted living is for people who need help with daily activities but don't need 24-hour skilled nursing care. A nursing home (also called a skilled nursing facility) is for people who need actual medical care, like wound care, IV therapy, or recovery supervision after surgery, delivered by licensed nurses around the clock. | Feature | Assisted Living | Nursing Home / SNF |
What does assisted living provide day to day?
On a normal day, assisted living typically provides three meals, help with bathing and dressing as needed, medication reminders or administration (depending on state rules and staff licensure), housekeeping, laundry, transportation to appointments, and organized social or recreational activities. Most buildings also provide 24-hour staff presence for emergencies, even if that staff isn't medically licensed. What it does not typically provide, unless the state license explicitly allows a higher level of care, is skilled nursing procedures, ventilator management, or intensive rehabilitation therapy. Some states allow "enhanced" or "limited nursing" assisted living tiers that permit a bit more medical involvement, like insulin administration by trained staff, but this varies enormously by state. Confirm with your state licensing agency exactly what your license tier permits before advertising any medical-adjacent service. For operators building out a facility assisted living program, the day-to-day service list in your policy manual has to match, almost word for word, what your state license category allows. Overpromising services on a website or brochure that your license doesn't cover is one of the more common inspection and consumer-complaint problems new operators run into.
How much does assisted living cost, and who actually pays for it?
Nationally, the last full Genworth Cost of Care Survey (2021, the final year Genworth ran it before discontinuing the survey) put the median monthly cost of assisted living at $4,500, compared to $7,908 for a semi-private nursing home room and $5,148 for a home health aide working roughly 44 hours a week [5]. Costs have almost certainly risen since 2021 with general inflation and labor cost increases in the sector, but this remains the most recent nationally consistent benchmark most planners and financial advisors still cite. Most assisted living costs are paid one of a few ways: private savings and income, long-term care insurance (if the person bought a policy years earlier), veterans' Aid and Attendance benefits for eligible wartime veterans and surviving spouses, or in some cases a state Medicaid Home and Community-Based Services waiver covering the service portion, with the resident's own income covering room and board. Medicare, as covered above, generally isn't part of this list at all. Families often assume Medicare will "kick in eventually" the way it does for hospital stays. It won't, and that assumption causes real financial planning problems when someone needs assisted living care and discovers the bill is entirely out of pocket, minus whatever Medicaid waiver or veterans benefit they separately qualify for.
Can Medicaid help cover assisted living costs?
Sometimes, for services, rarely for rent. Medicaid is a state-federal program, and most states run Home and Community-Based Services (HCBS) waivers that let Medicaid pay for personal care, case management, and some health-related services delivered inside an assisted living setting, as an alternative to paying for a nursing home stay. Medicaid.gov describes HCBS as letting people "receive services in their own home or community rather than institutions or other isolated settings" [6]. The catch: federal Medicaid rules generally don't let the program pay for room and board in assisted living the way it can in a nursing home. Some states work around this using a Medicaid HCBS waiver for the services plus a state Supplemental Security Income (SSI) optional state supplement, or a separate state-funded assistance program, to help low-income residents cover the room and board piece . Whether that combination exists, and how generous it is, varies enormously by state. This is a case where the honest answer is "it depends on your state," and there's no way around checking directly. Confirm with your state Medicaid agency and your state licensing agency which specific waiver programs apply to assisted living versus group home settings in your state, because eligibility rules, waiting lists, and income limits differ widely.
How do I start a group home?
Starting a group home is a licensing project first and a business project second. The rough sequence most states follow looks like this: pick the population you'll serve (seniors, IDD, mental health, recovery), identify the specific state agency that licenses that population's residential care, confirm zoning allows a group home use at your target property, write your policy and procedure manual to match that license category's requirements, build a staffing plan that meets minimum ratios, and submit your license application with the required fees and background checks. Every state runs this differently, with different agency names, different fee amounts, and different timelines, so treat any generic "how to" list as a starting checklist, not a substitute for reading your own state's regulations. Nobody can promise a fast approval or guarantee licensing, and any source that does isn't being straight with you. Some states process applications in a couple of months; others take considerably longer, especially if your first application has gaps. This is exactly the gap a template-based tool is built to close, since most of the paperwork structure (policy manual sections, staffing plan format, emergency procedures) repeats across states even though the specific numbers differ. GroupHomePath's $299 one-time State Group Home Licensing Kit walks through state-specific document structures so you're not starting from a blank page, though you'll still need to confirm exact fees, forms, and timelines with your own state licensing agency directly.
What licensing steps and paperwork does opening a group home actually require?
Most states ask for some version of the following, though names and order shift by state: a completed license application, proof of zoning compliance or a zoning variance, a facility policy and procedure manual covering health, safety, medication management, and emergency response, a staffing plan showing coverage ratios and required training, background checks and health screenings for staff, a fire and life-safety inspection, and a pre-licensing site inspection by the licensing agency. Separately from state licensing, expect a local zoning or planning department review, since group homes sit in a legally protected but still regulated category under fair housing law, and local rules about occupancy, parking, and building code still apply. If you're researching senior assisted living facilities near me as a competitive scan before opening your own, pay attention to what services nearby licensed operators advertise, since that tells you what your state's license tier typically permits. A policy manual isn't a formality. Inspectors read it, compare it against what they observe on-site, and cite gaps between the paper and the practice as violations. Whether you're planning a small assisted living at home model or a larger assisted living facility, build the manual around your actual, specific state statute language, not a generic template alone. That's where a state-specific kit earns its cost back versus writing from scratch.
Frequently asked questions
Does Medicare cover assisted living facilities at all?
No. Medicare doesn't cover the room, board, or personal care costs of assisted living because it classifies that as custodial care, not medical care. Medicare.gov states directly that it doesn't cover long-term care "if that's the only care you need" [1]. It will still pay for separate, medically necessary services like doctor visits or therapy delivered to a resident.
Does Medicare Advantage cover assisted living?
Not the rent or personal care. Some Medicare Advantage plans offer narrow supplemental benefits, like meal delivery or transportation, under CMS's expanded benefit rules that started in 2019 and 2020. These are plan-specific extras, not a way to cover an assisted living bill, and availability varies plan by plan and year by year.
Does Medicare pay for memory care?
No, memory care follows the same rule as standard assisted living: Medicare doesn't cover the residential and personal care costs, even in a dementia-specific unit. Medicare will cover related medical services, like a neurologist visit or physical therapy, delivered to that resident, but not the facility's monthly memory care rate.
Does Medicare cover room and board during hospice care in a facility?
No. Even under the Medicare hospice benefit, room and board in a facility like assisted living or a nursing home is not covered by Medicare itself [3]. The hospice benefit pays for hospice services (nursing visits, medications related to the terminal illness, equipment), but the facility's daily rate is a separate cost.
Does Medicaid cover assisted living?
Sometimes, for services only, through state Home and Community-Based Services waivers [4]. Federal Medicaid rules generally don't allow payment for room and board in assisted living the way they do in a nursing home. Some states add a state supplement to help cover room and board for low-income residents [7]. Confirm your specific state's waiver rules directly.
How much does assisted living cost without any insurance help?
The last national Genworth Cost of Care Survey (2021) put the median at $4,500 a month for assisted living, versus $7,908 for a semi-private nursing home room [5]. Costs vary a lot by state and city, and have likely risen since 2021, so treat this as a benchmark, not a current quote.
What's the difference between assisted living and independent living?
Independent living is basically an apartment community with amenities like dining and activities, built for people who don't need daily personal care help. Assisted living adds licensed staff support for bathing, dressing, medication, and mobility. If someone needs regular hands-on help with daily tasks, that's the line that usually moves them from independent to assisted living.
What's the difference between assisted living and a nursing home?
Assisted living provides housing and personal care help for people who are mostly mobile and don't need constant medical supervision. A nursing home (skilled nursing facility) provides 24-hour licensed nursing care for people with ongoing medical needs. Medicare can cover up to 100 days in a qualifying nursing home stay after a hospital admission, but generally not assisted living [2].
How many residents can a group home have?
It depends entirely on your state and license category, ranging widely from small homes around 4 to 8 residents up to larger licensed facilities with dozens of residents. There's no single national number. Confirm the exact resident cap tied to your specific license type with your state licensing agency before signing a lease or buying property.
Do I need a license to start a group home?
Yes, in every state, operating a residential care setting for people who need personal care assistance requires a state license, and operating without one is illegal and can expose you to fines or closure. The specific agency, application, and fee vary by state and by the population served (seniors, IDD, mental health, recovery).
How long does it take to get a group home license approved?
Timelines vary widely by state and depend heavily on how complete your application, policy manual, and staffing plan are on first submission. Some states process straightforward applications in a couple of months; others take considerably longer. No source can honestly guarantee a timeline or a fast approval; confirm current processing estimates with your state licensing agency.
Can veterans' benefits help pay for assisted living?
Yes, potentially. The VA's Aid and Attendance benefit is a pension add-on for eligible wartime veterans and surviving spouses who need help with daily activities, and it can be applied toward assisted living costs. It's separate from Medicare and has its own eligibility and asset rules through the Department of Veterans Affairs, not the assisted living facility itself.
Does long-term care insurance cover assisted living?
Often yes, if the policyholder bought a policy before needing care and it specifically includes assisted living as a covered setting. Coverage amounts, elimination periods, and daily benefit caps vary a lot by policy, so the actual payout depends entirely on the specific policy terms, not a general rule.
Sources
- Medicare.gov, Long-Term Care: Medicare doesn't cover long-term custodial care if that's the only care needed
- Medicare.gov, Skilled Nursing Facility (SNF) Care: Part A covers up to 100 days of SNF care per benefit period after a qualifying hospital stay
- Medicare.gov, Hospice Care: Room and board in a facility is not covered under the Medicare hospice benefit
- Medicaid.gov, Home & Community-Based Services: HCBS waivers let states pay for services in community settings rather than institutions
- Genworth, Cost of Care Survey 2021: Median monthly costs for assisted living, nursing home, and home health aide care in 2021
- Medicare.gov, Costs: SNF coinsurance for days 21 to 100 is set and adjusted annually by CMS