What Medicare does and doesn't pay
Medicare.gov says Medicare doesn't cover long-term care (also called custodial care) if that's the only care you need. Help with bathing, dressing, eating, medications and supervision is the core of assisted living, so Medicare doesn't pay the facility's monthly charge.
Medicare keeps covering your medical care while you live in assisted living or memory care: doctor visits, lab work, therapy, Part D drugs and, if you qualify, hospice care brought to you there.
How Oregon Medicaid helps
ODHS says Medicaid, called the Oregon Health Plan, "pays for long-term care for people who meet eligibility requirements," at home or in a facility. Oregon calls its facility options community-based care:
- Adult foster homes.
- Assisted living facilities.
- Residential care facilities, including memory care communities.
How payment works, under ODHS rules (OAR 411-027-0025):
- The facility must have a Medicaid contract. Not every Oregon facility does, so ask before you move in.
- You pay the facility a set room-and-board amount from your income and keep a monthly personal allowance.
- Income above those amounts goes toward your care, and ODHS pays the facility the rest of the service cost.
You must qualify financially and need help with daily activities. ODHS sets the amounts each year, so check current figures with ODHS.
How to get started in Oregon
- Call ODHS Aging and People with Disabilities. The state aging and disability agency explains long-term care options and Medicaid: 1-855-673-2372.
- Apply for Medicaid. Apply online through ONE Oregon (benefits.oregon.gov), call 1-800-699-9075, or visit a local ODHS office.
- Ask facilities about their Medicaid contract. Confirm before you sign an agreement.
If you don't qualify for Medicaid, Oregon Project Independence can help some people 60 and older stay at home, with fees on a sliding scale. See What is Oregon Project Independence? and Medicare and OHP together.
Related questions
Does Medicare cover memory care in Oregon?
Dementia care and who pays.
Does Medicare cover a nursing home in Oregon?
Short-term skilled care only.
Does Medicare pay for in-home caregivers in Oregon?
Personal care at home.
How do I qualify for Medicaid long-term care in Oregon?
Oregon's eligibility steps.
Sources
- Medicare.gov — Long-term care
- Oregon Department of Human Services — Long-term care
- Oregon Department of Human Services — Medicaid services and supports: community-based care facility options
- Oregon Department of Human Services — OAR chapter 411, division 27 (payment for community-based care)
More questions in this guide
- Does Medicare cover acupuncture in Oregon?
- Does Medicare cover ambulance service in Oregon?
- Does Medicare cover annual physicals in Oregon?
- Does Medicare cover bone density tests in Oregon?
- Does Medicare cover cataract surgery in Oregon?
- Does Medicare cover chiropractic care in Oregon?
- Does Medicare cover a colonoscopy in Oregon?
- Does Medicare cover CPAP machines in Oregon?
- Does Medicare cover dental care in Oregon?
- Does Medicare cover diabetic supplies in Oregon?
- Does Medicare cover flu shots in Oregon?
- Does Medicare cover hearing aids in Oregon?
- Does Medicare cover home health care in Oregon?
- Does Medicare pay for in-home caregivers in Oregon?
- Does Medicare cover mammograms in Oregon?
- Does Medicare cover me when I travel or spend winters outside Oregon?
- Does Medicare cover medical marijuana in Oregon?
- Does Medicare cover memory care in Oregon?
- Does Medicare cover mental health care in Oregon?
- Does Medicare cover naturopathic doctors in Oregon?
- Does Medicare cover nursing home care in Oregon?
- Does Medicare cover oxygen therapy in Oregon?
- Does Medicare cover physical therapy in Oregon?
- Does Medicare cover prostate cancer screening in Oregon?
- Does Medicare cover psilocybin therapy in Oregon?
- Does Medicare cover skilled nursing care in Oregon?
- Does Medicare cover the shingles vaccine in Oregon?
- Does Medicare cover transportation to medical appointments in Oregon?
- Does Medicare cover vision care in Oregon?
- Does Medicare cover wheelchairs in Oregon?
Part of the guide: Learn Medicare — the Oregon starter guide · All questions
Frequently asked questions
Does Oregon Medicaid pay for room and board in assisted living?
Generally no. Under ODHS rules, a Medicaid resident pays the facility a set room-and-board amount from their own income, and ODHS pays for the care services. ODHS may help with room and board if your income is below that amount.
Can an Oregon facility charge a Medicaid resident extra?
ODHS says a facility can't charge a Medicaid resident more than the monthly room and board and any required share of the service cost. It can still charge for optional extras such as a hairdresser or cable.
Does Medicare pay for a short stay after a hospital discharge?
Medicare Part A can cover skilled nursing facility care for a limited time after a qualifying inpatient hospital stay. That is skilled care in a nursing facility, not assisted living.
Who do I call in Oregon about long-term care?
ODHS Aging and People with Disabilities can explain long-term care options and Medicaid: 1-855-673-2372. To apply for benefits, use ONE Oregon online or call 1-800-699-9075.
Medicare in your Oregon county
Plans, local agents and help, county by county: Multnomah · Washington · Clackamas · Lane · Marion · Jackson · Deschutes · Linn · Douglas · Yamhill · Benton · Polk · Josephine · Umatilla · Klamath · Coos · Columbia · Lincoln · Clatsop · Malheur · All 36 counties →
