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What Medicare Does and Does Not Pay For

Medicare covers short skilled nursing stays, home health and hospice. It does not pay for assisted living or custodial care, in any state.

HomeCosts & PayingWhat Medicare Does and Does Not Pay For
Short answer

Medicare does not pay for assisted living, memory care, or long-term custodial care anywhere in the country. It covers limited skilled nursing facility stays after a qualifying hospital admission, intermittent skilled home health, and hospice.

What Medicare covers

  • Skilled nursing facility care after a qualifying inpatient hospital stay, for a limited period, when skilled care is needed daily. This is rehabilitation, not long-term placement.
  • Home health that is intermittent and skilled — nursing visits, physical, occupational or speech therapy. Not a caregiver who stays with your parent.
  • Hospice — the hospice team, medications related to the terminal diagnosis, and equipment. Not room and board in a facility.
The observation status trap. A Medicare skilled nursing benefit requires a qualifying inpatient hospital admission. Time spent under “observation status” does not count, even if your parent slept two nights in a hospital bed. Ask the hospital directly whether your parent is admitted as an inpatient or under observation, and ask in writing.
What senior care costs. New York's CareScout median is $7,110/month for assisted living and $16,729/month for a private nursing home room. Read the full explanation →

Questions families ask

Does Nassau County or Suffolk County have a bigger, more spread-out senior care market?

Suffolk County's senior care market is more geographically spread out, stretching from denser, transit-served western hamlets such as Huntington, Brentwood, Bay Shore, and Islip to more rural, exurban North and South Fork communities that have become popular retirement-relocation destinations. Nassau County's market is more geographically compact, concentrated along its village and LIRR corridor towns, including Garden City, Rockville Centre, Great Neck, Freeport, Long Beach, and Mineola.

What's the difference between standard assisted living and memory care in New York?

Standard assisted living in New York is licensed as an Assisted Living Residence (ALR) under 10 NYCRR Part 1001. Memory care is not a separate license; it's delivered through a Special Needs Assisted Living Residence (SNALR) certification, an additional certification an ALR can obtain to serve residents with dementia or cognitive impairments per an Individualized Service Plan, regulated under the same Part 1001 rules.

What's the difference between a nursing home and an assisted living residence in New York, regulation-wise?

Nursing homes are licensed under 10 NYCRR Part 415, Nursing Homes - Minimum Standards, a distinct regulatory chapter focused on skilled, medically intensive care. Assisted Living Residences are licensed under 10 NYCRR Part 1001, and can only exist as an additional certification on top of an already-licensed Adult Home or Enriched Housing Program, themselves licensed under 18 NYCRR Parts 487 and 488.

At what point does hourly in-home care cost more than assisted living in New York?

Using CareScout's 2025 New York State medians, in-home non-medical caregiving costs $35 per hour, or about $6,673 per month at 44 hours a week, compared to assisted living's median of $7,110 per month ($225 per day). At roughly 45 to 46 hours per week of paid in-home care, the monthly cost crosses over and exceeds the assisted living median; families needing care beyond that, including any overnight or 24/7 coverage, would generally spend more on home care than on a private one-bedroom assisted living apartment.

What's the difference between a CCRC or Life Plan Community and a standalone assisted living or nursing facility on Long Island?

A Continuing Care Retirement Community (CCRC), also called a Life Plan Community, offers a full continuum of care, independent living, assisted living, memory care, and skilled nursing, on one campus, so a resident can move between levels of care as needs change without relocating to a different facility or provider. Long Island examples include Jefferson's Ferry in South Setauket, which describes itself as Long Island's first Life Plan Community, and Peconic Landing in Greenport, which describes itself as New York's only equity-based CCRC; a standalone assisted living or nursing facility, by contrast, offers only one level of care and requires a resident to move elsewhere if their needs change.

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