Dayton Senior AdvisorDoes Medicare pay for assisted living in Ohio?
No. Medicare does not pay for room, board or personal care in an assisted living facility, in Ohio or anywhere; it pays only for covered medical services a resident receives there, such as doctor visits, home health or hospice.
That surprises many families. Paying for an RCF in the Dayton area falls to private funds, long-term care insurance, VA pension or, for those who qualify, Ohio's Assisted Living Waiver for the care portion.
When does Medicare pay for a nursing home stay?
Medicare Part A pays for skilled nursing or rehab in a certified nursing home after a qualifying inpatient hospital stay of at least three days, when the patient needs daily skilled care, for up to 100 days per benefit period: the first 20 in full and the rest with a daily coinsurance.
Time spent under “observation” in Miami Valley Hospital or a Kettering Health campus does not count toward the three days, so ask the hospital whether your parent is formally admitted. Coverage ends when the patient stops improving or no longer needs daily skilled care, often well before day 100. Medicare Advantage plans set their own rules and usually require prior authorization.
What home health care does Medicare cover?
Medicare covers part-time skilled nursing, physical, occupational and speech therapy and some aide visits at home for a patient who is homebound and under a doctor's plan of care, with no copay for the visits.
ODH's roster shows 87 skilled home health agencies, 211 non-medical home health agencies and 11 hospice care programs with offices in the six counties. Medicare does not pay for hourly companionship or round-the-clock aides; those come from non-medical agencies, paid privately or through PASSPORT. Ask the discharge planner which certified agencies serve your parent's ZIP code and how quickly each can start.
What does Medicare's hospice benefit cover?
For a patient whose doctor certifies a life expectancy of six months or less, Medicare's hospice benefit covers the hospice team, medications and equipment related to the terminal illness, and short inpatient or respite stays, wherever the patient lives.
ODH lists 11 licensed hospice care programs with offices in the six counties: Cherish Hospice LLC (Springfield), Everheart Hospice (Greenville), Adoration Hospice (Beavercreek), Hospice of Miami County (Troy), Capital Health Hospice (Miamisburg), Caretenders Hospice (Moraine), Compassus - Western Ohio (Dayton), Crossroads Hospice of Dayton, LLC (Dayton), Heartland Hospice (dayton) (Kettering), Hospice of Dayton (Dayton), Interim Healthcare Hospice of Dayton (Huber Heights). Hospice does not pay room and board in an RCF or nursing home. Patients can leave hospice and return later, and the six-month estimate can be renewed.
Where can Dayton families get unbiased Medicare help?
From OSHIIP, the Ohio Senior Health Insurance Information Program run by the Ohio Department of Insurance, whose trained counselors compare plans and explain coverage free of charge; call 1-800-686-1578.
The open enrollment period each fall is the time to check whether a Medicare Advantage plan's skilled nursing and home health networks include the providers your parent would want. For people with both Medicare and Medicaid, Ohio's managed care arrangements are changing, so confirm plan options with Ohio Medicaid before choosing.
Side by side
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Rehab | Up to 100 days of skilled nursing after a qualifying hospital stay | Long-term custodial nursing home care |
| Home | Skilled home health for homebound patients | Hourly non-medical aides |
| End of life | Hospice team, drugs and equipment | Room and board in a facility |
| Assisted living | Medical services received there | Rent or personal care |
Drawn from Ohio Revised Code Chapter 3721, Ohio Administrative Code Chapters 3701-16 and 5160:1-6, ODH and Ohio Department of Aging publications, Ohio Medicaid letters, CareScout, CMS and the VA; our editorial standards explain how we check them.
