Does Medicare pay for assisted living in Utah?
No. Medicare does not pay for assisted living room, board or personal care in Utah or anywhere else; it pays for medical services a resident receives there, such as doctor visits, home health visits and hospice.
That gap is why most Salt Lake families pay privately for assisted living at first, then look at the New Choices Waiver once a parent has been in a licensed facility long enough and their resources meet Medicaid limits.
When does Medicare pay for a nursing home stay?
Medicare Part A covers a skilled nursing facility stay for up to 100 days per benefit period when a person needs daily skilled care after an inpatient hospital stay of at least three days, with full coverage only for the first 20 days and a daily coinsurance after that.
“Observation” days in a hospital do not count toward the three inpatient days, which catches many families off guard after a fall. Ask the hospital case manager at Intermountain Medical Center, the University of Utah, St. Mark's or wherever your parent is whether they are an inpatient. Medicare also stops paying when skilled care is no longer needed, even if day 100 has not arrived.
Does Medicare pay for home care in Salt Lake City?
Medicare pays for part-time skilled home health care from a certified agency when a person is homebound and needs skilled nursing or therapy under a doctor's plan, but it does not pay for non-medical help such as bathing, companionship or homemaking on its own.
In Utah, non-medical in-home help is provided by licensed personal care agencies and paid privately, through long-term care insurance, or through the Aging Waiver. See our home health vs. personal care agency comparison.
Does Medicare cover hospice in assisted living?
Yes. Medicare's hospice benefit covers hospice care for a person with a terminal prognosis who chooses comfort care, wherever they live, including a Utah assisted living facility, though it does not pay the facility's room and board.
Utah's assisted living rule allows hospice residents to stay with safeguards; see hospice in assisted living.
Where can Salt Lake seniors get free Medicare counseling?
Utah's SHIP Medicare counselors give free, unbiased help; in Tooele County they are reached through Tooele County Aging Services at 435-277-2420, and Salt Lake County residents can start with Salt Lake County Aging & Adult Services at 385-468-3200.
Counselors can compare Medicare Advantage and Medigap options, check prescription plans, and explain how a plan handles skilled nursing and home health. Bring the plan's evidence of coverage to the appointment.
At a glance
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Facilities | Short skilled nursing stays after a qualifying hospital admission | Assisted living or long-term custodial care |
| At home | Part-time skilled home health for homebound patients | Non-medical help such as bathing or homemaking alone |
| End of life | Hospice care wherever the person lives | Room and board while on hospice |
| Advice | Free SHIP counseling (federally funded) | Paid advisers' plan recommendations |
Sources include Utah Admin. Code R432-270, Utah DHHS and DLBC pages, Salt Lake County and DAAS pages, CareScout and VA rate tables as cited above; see our editorial standards.
