Charleston Senior AdvisorDoes Medicare pay for assisted living in South Carolina?
No. Medicare does not pay for rent, meals or personal care in a CRCF or any other assisted living setting; it pays only for covered medical services a resident receives there, such as doctor visits, therapy, home health and hospice.
This is the single most common misunderstanding families bring to a first call. Assisted living in South Carolina is paid privately, through long-term care insurance or VA pension, or, for people with low income, through Optional State Supplementation or Community Choices Residential Personal Care in participating buildings.
How long will Medicare pay for a rehab stay?
Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period after a qualifying inpatient hospital stay of at least three days: days 1 through 20 at no cost and days 21 through 100 with a daily coinsurance, for as long as daily skilled care is needed.
The three days must be as an admitted inpatient. Time spent under observation status does not count, and that technicality catches many families leaving Lowcountry hospitals. Ask in writing whether your parent is admitted or under observation. Medicare Advantage plans may waive the three-day rule but usually require prior authorization and use their own network of nursing homes.
Does Medicare cover care at home?
Yes, when a doctor certifies that the patient is homebound and needs intermittent skilled nursing or therapy; Medicare then pays a certified home health agency for those visits, along with part-time aide help tied to the plan, at no cost to the patient.
In the tri-county area DPH's data shows 15 licensed home health agencies, 10 hospice programs, 1 inpatient hospice house and 136 licensed in-home care providers with local offices. What Medicare will not pay for is hourly companion care, homemaker help or round-the-clock aides. Those come from licensed in-home care providers and are paid privately, through long-term care insurance, VA benefits or the Community Choices waiver.
Does Medicare cover hospice in assisted living or a nursing home?
Yes. The Medicare hospice benefit covers the hospice team, drugs and equipment related to the terminal illness wherever the patient lives, including a CRCF or nursing home, for a patient whose physician certifies a life expectancy of six months or less if the illness follows its usual course.
It does not pay the facility's room and board. Short inpatient stays for symptom control or caregiver respite are covered in a hospice inpatient setting; DPH's data lists 10 licensed hospice programs with offices in the three counties and 1 inpatient hospice house: Lowcountry Community Hospice House (Summerville, 30 beds).
Where can Charleston-area seniors get free Medicare advice?
From SHIP, the State Health Insurance Assistance Program known in South Carolina as I-CARE, which the Trident Area Agency on Aging runs for Berkeley, Charleston and Dorchester counties (843-554-2275).
Counselors explain Original Medicare and Medicare Advantage, Part D drug plans, Medigap and the programs that help with costs, such as the Medicare Savings Programs and Extra Help. They sell nothing. Medicare's annual open enrollment runs October 15 to December 7.
Side by side
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Facility care | Up to 100 days of skilled nursing after a qualifying stay | Assisted living rent or long-term nursing home care |
| At home | Skilled home health visits for homebound patients | Hourly companions or 24-hour aides |
| End of life | Hospice team, drugs and equipment | Room and board where the patient lives |
| Advice | Free SHIP counseling (through the Trident AAA) | Paid insurance agents |
Sources: S.C. Code Regs. 60-84, DPH Healthcare Quality, SCDHHS bulletins and charts, CareScout, CMS and VA rate tables, as cited in each answer. See our editorial standards.
