Greenville Senior AdvisorDoes Medicare pay for assisted living in South Carolina?
No. Medicare does not pay 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, home health visits and hospice.
That is the most common misunderstanding families bring to a first conversation. Assisted living in South Carolina is paid privately, through long-term care insurance, VA pension, or, for people with low income, Optional State Supplementation or Community Choices Residential Personal Care in participating CRCFs.
How long does Medicare pay for a nursing home 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 to 20 at no cost, and days 21 to 100 with a daily coinsurance, as long as the patient needs and is improving with or maintained by daily skilled care.
The three-day stay must be as an admitted inpatient; days under observation status do not count, and that distinction catches many Upstate families. Ask the hospital in writing whether your parent is admitted or under observation. Medicare Advantage plans may waive the three-day rule but often require prior authorization and use their own network of nursing homes.
Does Medicare pay for home health care?
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, plus part-time home health aide help tied to the plan, at no cost to the patient.
DPH's data shows 13 licensed home health agencies, 17 hospice programs, 3 inpatient hospice houses and 295 licensed in-home care providers with offices in the four counties. Medicare does not pay for hourly companion care, homemaker services or round-the-clock aides. Those come from licensed in-home care providers, paid privately, through long-term care insurance, VA benefits or the Community Choices waiver.
Does Medicare cover hospice in a Greenville CRCF or nursing home?
Yes. Medicare's hospice benefit covers the hospice team, medications and equipment related to the terminal illness wherever the patient lives, including a CRCF or nursing home, for patients whose physician certifies a life expectancy of six months or less if the illness runs its normal course.
It does not pay the facility's room and board. Short inpatient stays for symptom control and respite are covered at a hospice inpatient unit or contracted facility; the Upstate's licensed hospice houses are in Simpsonville, Anderson and Clinton.
Where can Greenville seniors get free Medicare counseling?
From I-CARE, South Carolina's State Health Insurance Assistance Program, run locally by the Appalachian Council of Governments Area Agency on Aging (864-242-9733) for Greenville, Anderson and Pickens counties and by Upper Savannah COG for Laurens County.
Counselors explain Original Medicare and Medicare Advantage, Part D drug plans, Medigap and help with costs such as the Medicare Savings Programs and Extra Help. They are not selling anything. Open enrollment for Medicare plans runs October 15 to December 7 each year.
At a glance
| Medicare covers | Medicare does not cover | |
|---|---|---|
| Nursing homes | Up to 100 skilled days after a 3-day inpatient stay | Long-term custodial care |
| At home | Intermittent skilled home health visits | Hourly or live-in aides |
| Assisted living | Medical services delivered there | Rent, meals or personal care |
| End of life | Hospice team, drugs and equipment | Facility room and board |
Sources include S.C. Code Regs. 60-84, DPH Healthcare Quality and SCDHHS pages and bulletins, CareScout, CMS and VA rate tables as cited above; see our editorial standards.
