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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.

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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

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.

Who regulates assisted living facilities on Long Island?

New York State Department of Health (NYSDOH) licenses and regulates assisted living as part of its Adult Care Facility (ACF) program, which covers Adult Homes, Enriched Housing Programs, and Assisted Living Residences (ALR). Long Island facilities are overseen locally through NYSDOH's Metropolitan Area Regional Office - Long Island (MARO-LI) in Central Islip. Nursing homes are licensed separately by NYSDOH under a different set of regulations (10 NYCRR Part 415).

What's the difference between an Adult Home, Enriched Housing Program, and Assisted Living Residence in NY?

Adult Homes and Enriched Housing Programs (EHP) are New York's two base licensed categories providing room, board, housekeeping, and personal care to five or more unrelated adults, with EHP generally serving residents 65+ in more independent, apartment-style settings. An Assisted Living Residence (ALR) is an additional certification layered on top of an existing Adult Home or EHP license - it cannot exist as a standalone building type. Adult Homes and EHPs are regulated under 18 NYCRR Parts 487 and 488; ALRs are regulated under 10 NYCRR Part 1001.

How do I check if a Long Island assisted living facility has a clean inspection record?

New York State publishes licensing status and inspection history for every Adult Care Facility, including Assisted Living Residences, on the NYS Health Profiles website (profiles.health.ny.gov/acf), searchable by county, name, or facility type. Each facility's profile page includes an Inspections tab showing survey results. NYSDOH also publishes a statewide Consumer Information Guide: Assisted Living Residence that explains how to read these records.

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