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What Medicare Does and Does Not Pay For

Medicare covers short skilled nursing stays, home health and hospice. It does not pay for assisted living or custodial care, in any state.

HomeCosts & PayingWhat Medicare Does and Does Not Pay For
Short answer

Medicare does not pay for assisted living, memory care, or long-term custodial care anywhere in the country. It covers limited skilled nursing facility stays after a qualifying hospital admission, intermittent skilled home health, and hospice.

What Medicare covers

  • Skilled nursing facility care after a qualifying inpatient hospital stay, for a limited period, when skilled care is needed daily. This is rehabilitation, not long-term placement.
  • Home health that is intermittent and skilled — nursing visits, physical, occupational or speech therapy. Not a caregiver who stays with your parent.
  • Hospice — the hospice team, medications related to the terminal diagnosis, and equipment. Not room and board in a facility.
The observation status trap. A Medicare skilled nursing benefit requires a qualifying inpatient hospital admission. Time spent under “observation status” does not count, even if your parent slept two nights in a hospital bed. Ask the hospital directly whether your parent is admitted as an inpatient or under observation, and ask in writing.
What senior care costs. Wisconsin's 2024 CareScout state medians were $73,800/yr for assisted living and $120,815-$135,050/yr for a nursing home room; no metro-specific or memory-care figure is published anywhere. Read the full explanation →

Questions families ask

Does the Milwaukee metro include Racine?

No. This site's coverage area is the 4-county core Milwaukee-Waukesha-West Allis Metropolitan Statistical Area as defined by the U.S. Census Bureau -- Milwaukee, Waukesha, Ozaukee, and Washington counties. Racine forms its own separate Metropolitan Statistical Area under Census Bureau delineation.

Does Wisconsin have one 'assisted living license' like some other states?

No. Wisconsin runs four separate license/certification types -- Community-Based Residential Facility (CBRF), Residential Care Apartment Complex (RCAC), Adult Family Home (AFH), and nursing home -- each licensed by the DHS Division of Quality Assurance, Bureau of Assisted Living, under different rule chapters. There is no single umbrella 'assisted living' license the way some states use the term.

What is a CBRF in Wisconsin?

A Community-Based Residential Facility (CBRF) is a residential setting where 5 or more unrelated adults live together and receive room and board, supervision, and support services, plus up to 3 hours of nursing care per week per resident. CBRFs are licensed under Wis. Admin. Code ch. DHS 83 by the DHS Bureau of Assisted Living.

What is an RCAC and how is it different from a CBRF?

A Residential Care Apartment Complex (RCAC) offers independent apartment units, not shared rooms, where residents receive room and board, personal care, and nursing services -- up to 28 hours per week of supportive care per resident, a materially higher ceiling than a CBRF's 3 hours. Both are licensed/certified by the DHS Bureau of Assisted Living.

What is an Adult Family Home (AFH) in Wisconsin?

An Adult Family Home is a private home where 3 or 4 unrelated adults reside and receive care, including up to 7 hours per week of nursing care per resident, licensed by the DHS Bureau of Assisted Living. Smaller 1-2 bed adult family homes are regulated separately, under DHS's Division of Medicaid Services rather than DQA licensing.

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