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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.

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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

What's the difference between reporting to Adult Protective Services and filing a complaint with the state about a facility?

APS investigates suspected abuse, neglect, financial exploitation, or self-neglect involving an individual adult, administered county-by-county. A facility-standards complaint (about licensing compliance, staffing, or care quality at a specific CBRF, RCAC, adult family home, or nursing home) goes to DHS's Bureau of Assisted Living instead.

What VA benefits can help pay for senior care for a Milwaukee-area veteran?

The VA's Aid and Attendance pension is the most relevant benefit for many veterans and surviving spouses needing help paying for assisted living, memory care, or in-home care -- it's a needs-based benefit added on top of a wartime veteran's basic pension, using unreimbursed medical expenses to increase the benefit amount.

Is the VA's Aid and Attendance benefit the same everywhere, or does it vary by state?

It's the same everywhere. VA Aid and Attendance rates are federal and identical nationwide, including for veterans and survivors living in the Milwaukee metro -- they are not Wisconsin-specific and don't vary by county within the state either.

Can a veteran use both VA Aid and Attendance and Wisconsin Medicaid (Family Care/IRIS) at the same time?

In many cases, yes, though the specific interaction between VA pension income and Wisconsin Medicaid's income/asset eligibility rules requires individual review -- talk to your county ADRC's benefits specialist or a VA-accredited benefits counselor before assuming how the two programs interact for your specific situation.

Where is the nearest VA medical center for a Milwaukee-area veteran?

The Clement J. Zablocki VA Medical Center, part of the Milwaukee VA Medical Center campus, serves as the primary VA hospital for veterans in the Milwaukee metro. Veterans should confirm current services and any additional community-based outpatient clinic locations directly at va.gov.

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