What Medicare does and doesn't pay
Medicare.gov says Medicare doesn't cover long-term care, also called custodial care, when it's the only care you need. That includes help with bathing, dressing and eating, and the rent and meals at an assisted living community. While you live in assisted living, Medicare still covers:
- Doctor visits, hospital stays and outpatient care.
- Home health care from a Medicare-certified agency, if you meet Medicare's homebound and skilled-care rules.
- Hospice care, and short skilled nursing facility stays after a qualifying hospital stay.
- Prescription drugs through a Part D plan.
Ohio's Assisted Living Waiver
The waiver is an Ohio Medicaid program (OAC 5160-33-03) operated with the Ohio Department of Aging. It pays for assisted living services in facilities that are licensed as residential care facilities by the Ohio Department of Health and certified by the Department of Aging.
| Question | Answer |
|---|---|
| Who can enroll? | Adults 21 and older who need a nursing-home level of care and meet Medicaid's income and asset rules |
| What it covers | 24-hour on-site response, personal care, housekeeping and laundry, nursing, three meals a day, activities, and help moving out of a nursing home |
| What you pay | The state-set monthly room and board, and, depending on income, part of the cost of services |
| How to start | Call 1-866-243-5678 for your area agency on aging |
If you're in MyCare Ohio, assisted living services come through the MyCare Ohio Waiver instead; ask your plan's care coordinator. Ohio Medicaid's asset limits are strict, so see Ohio Medicaid and Medicare before you apply.
The Residential State Supplement
Under Ohio Revised Code 5119.41, the Ohio Department of Behavioral Health runs the Residential State Supplement, a monthly payment that adds to the SSI or Social Security of aged, blind or disabled adults at risk of needing institutional care, to help pay for accommodations, supervision and personal care in an approved setting. Your county Job and Family Services office checks income and resources.
Choosing a residence
- Check the license. Ask whether the residence is a licensed residential care facility, and whether it accepts the Assisted Living Waiver.
- Ask what happens if needs grow. Find out when a resident must move to a nursing home.
- Know who to call. Ohio's State Long-Term Care Ombudsman (1-800-282-1206) helps residents of assisted living and nursing homes with complaints.
A licensed insurance agent who works with Benefits Life can explain how Medicare and Medicare Advantage work when you move to assisted living, at no cost to you. You can request a call from a licensed insurance agent.
Related questions
Does Medicare cover nursing home care?
The 100-day skilled care rule.
Does Medicare cover home health care?
Skilled care at home.
What is the PASSPORT waiver?
Care at home for Ohioans 60+.
Sources
- Medicare.gov — Long-term care
- Ohio Department of Aging — Assisted Living Medicaid Waiver Program (August 2024)
- Ohio Administrative Code — Rule 5160-33-03, Assisted living program eligibility
- Ohio Revised Code — Section 5119.41, Residential state supplement program
- Ohio Department of Medicaid — Next Generation MyCare Member Frequently Asked Questions (April 2026)
- Ohio Department of Aging — Regional long-term care ombudsman contacts
More questions in this guide
- Can I keep my doctor when I go on Medicare in Ohio?
- Does Medicare cover dental in Ohio?
- Does Medicare cover diabetes supplies in Ohio?
- Does Medicare cover eye exams and glasses in Ohio?
- Does Medicare cover hearing aids in Ohio?
- Does Medicare cover home health care in Ohio?
- Does Medicare cover mental health care in Ohio?
- Does Medicare cover nursing home care in Ohio?
- How do I get rides to the doctor with Medicare in Ohio?
Part of the guide: Medicare basics for Ohioans · All questions
Frequently asked questions
Who qualifies for Ohio's Assisted Living Waiver?
The Ohio Department of Aging says you must be 21 or older, need hands-on help with daily activities such as bathing or getting around, meet Ohio Medicaid's financial rules, and be able to pay the state-set monthly room and board. Your county Job and Family Services office decides financial eligibility.
How do I apply for the Assisted Living Waiver?
Call 1-866-243-5678 to reach the area agency on aging serving your community. You complete an application, a phone screening and an in-person assessment, and your county Job and Family Services office decides financial eligibility.
Does Medicare Advantage pay for assisted living?
Assisted living rent and custodial care aren't Medicare benefits. Medicare Advantage plans cover what Original Medicare covers while you live in assisted living, such as doctor visits and hospital care. Check a plan's Evidence of Coverage for anything else.
Medicare in your Ohio county
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