Last verified: October 2026. Figures and rules are re-checked against primary sources.
Does Medicare pay for assisted living or memory care in Virginia?
No. Medicare does not pay for assisted living, memory care room and board, or long-term custodial care, in Virginia or anywhere else. Custodial care means help with bathing, dressing, eating and supervision. Medicare will still pay for covered doctor visits, therapy and medical services a resident receives while living there.
This is the most common surprise for Hampton Roads families, particularly military retirees who assume TRICARE For Life and Medicare together cover a move. They cover medical bills, not the monthly rent and care fee. For what residents typically pay, see what senior care costs in Virginia.
How does Medicare cover a skilled nursing facility stay in 2026?
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 have no coinsurance. Days 21 through 100 carry a daily coinsurance, which is $217 a day in 2026.
The care must be skilled, such as therapy after a hip fracture or wound care ordered by a physician, and the patient must keep improving or need daily skilled service. When therapy ends, coverage ends, even if day 100 has not arrived.
| Days in the facility | What you pay in 2026 |
|---|---|
| Days 1-20 | No coinsurance |
| Days 21-100 | $217 a day |
| After day 100 | Everything, unless other coverage applies |
What is the observation stay trap at Hampton Roads hospitals?
Observation days do not count toward the three-day qualifying inpatient stay, so a patient held in observation for two or three nights at Sentara Norfolk General or Riverside Regional can leave with no skilled nursing coverage. Observation is a billing status, and the patient is still in a hospital bed.
Ask the nurse or case manager every day: "Is my mother admitted as an inpatient or under observation?" If she is under observation, ask why, and who can review it. Do not assume that days in an emergency department or observation will count later. This question matters most for older adults arriving after a fall; see what to do after a fall and planning a hospital discharge.
When does Medicare pay for home health care in Hampton Roads?
Medicare pays for home health care when a physician certifies that the patient needs skilled services, such as nursing or therapy, and is largely unable to leave home. It covers part-time skilled visits, not an aide who stays for hours to provide company and daily help.
Families sometimes confuse home health with the non-medical home care described in our cost data, which is paid privately. A nurse who changes a dressing may be covered while the aide who helps your father bathe is not. Browse the home health directory for agencies serving your locality, and ask each whether it is Medicare-certified.
What does Medicare's hospice benefit cover for Virginia families?
Medicare's hospice benefit covers the hospice team, drugs and equipment related to the terminal illness. It does not pay room and board in a facility. A person living in assisted living or a nursing home still pays the monthly rent, and hospice comes to them in place.
This matters for planning because a parent can stay in an assisted living apartment with hospice support only if the facility's rules allow it; Virginia limits some conditions an assisted living facility may keep. Our admission limits guide explains those limits. To find providers, use the hospice directory.
Where can Hampton Roads families get free help sorting out coverage?
Your area agency on aging is a free starting point. Senior Services of Southeastern Virginia, 757-461-9481, serves Chesapeake, Isle of Wight, Norfolk, Portsmouth, Suffolk and Virginia Beach. The Peninsula Agency on Aging, 757-873-0541, serves Hampton, James City County, Newport News, Poquoson, Williamsburg and York County.
Gloucester families can call Bay Aging at 804-758-2386. Bring the Medicare card, any supplemental or TRICARE For Life card, and the hospital paperwork showing whether the stay was inpatient or observation. Ask the agency whether it can point you to a counselor who can sort out which bills belong to which payer. The call costs nothing and does not commit you to a particular provider or community.
What should families do when Medicare coverage ends?
Plan for the end of coverage before it arrives. Ask the facility or hospital team for the expected last covered day, then compare private pay, a move to assisted living, care at home, or Medicaid. Each path has its own application timeline, and the Medicaid one can take weeks.
If your parent will need long-term nursing facility care and has few assets, read nursing home Medicaid and spouses. If the plan is home care, look at the CCC Plus Waiver. We are paid by communities when a referred family moves in, but we will tell you when staying home is the better answer.
| Medicare generally covers | Medicare generally does not cover | |
|---|---|---|
| Nursing facility | Up to 100 skilled days after a three-day inpatient stay | Long-term custodial care in a nursing home |
| Assisted living | Doctor visits and medical care received there | Rent, meals and daily help in assisted living |
| Memory care | Covered medical services for the resident | Memory care room and board |
| Hospice | The hospice team, drugs and equipment for the terminal illness | Room and board in a facility |
| Cost sharing | Days 1-20 with no coinsurance | Days 21-100 cost $217 a day in 2026 |
