Navigating Medicare & Medicaid

Medicare generally does not cover long-term room and board in assisted living or memory care. However, it may cover medical services, doctor visits, or therapy a resident receives while living there.

Medicare may pay for a limited skilled nursing facility (SNF) stay (up to 100 days) following a qualifying 3-day inpatient hospital stay, provided the patient requires skilled nursing or rehabilitative services.

Yes. Medicaid is the largest payer for nursing facility care in the U.S. for individuals who meet their state's financial and functional eligibility requirements.

Often yes. Through Home and Community-Based Services (HCBS) waivers, Medicaid can fund personal care, meal support, and respite that allows seniors to age in place. Note that these programs often have waitlists.

While the federal government sets baseline requirements, states administer their own Medicaid programs. This allows them to decide specific income limits, covered services, and waiver programs.

Dual eligibility occurs when an individual qualifies for both Medicare and Medicaid. In these cases, Medicare typically pays first for medical needs, and Medicaid helps cover premiums, cost-sharing, and long-term care services.