Paying for assisted living in North Carolina
In North Carolina, assisted living communities are licensed as adult care homes (smaller homes with two to six beds are called family care homes). Most families pay for assisted living privately at first, using a mix of retirement savings, Social Security, pensions, the sale of a home, long-term care insurance, or help from family.
Costs vary widely by region and by the level of care a resident needs. You can compare current pricing for specific communities in the pricing tables below on this page.
Public programs can help certain residents, but they work differently than many people expect. The two that matter most are North Carolina Medicaid (including its Personal Care Services benefit and State-County Special Assistance) and Medicare.
Does North Carolina Medicaid cover assisted living in North Carolina?
North Carolina Medicaid can help pay for the care a resident receives in a licensed adult care home, but it never pays for room and board (rent and meals). Two programs work together:
- Personal Care Services (PCS): A Medicaid State Plan benefit that pays for hands-on help with activities of daily living (bathing, dressing, eating, toileting, and mobility) for eligible residents in licensed adult care homes.
- State-County Special Assistance (SA): A cash supplement that helps low-income residents with the room-and-board cost of an approved adult care home. People who qualify for Special Assistance are automatically eligible for Medicaid.
Eligibility is based on age or disability, income, assets, and a documented need for help with daily activities. The community must accept the state Special Assistance rate.
How to apply: Contact your county Department of Social Services to apply for Special Assistance and Medicaid; PCS eligibility involves a separate independent assessment of care needs.
Does Medicare cover assisted living in North Carolina?
No. Medicare does not pay for assisted living room and board or for long-term custodial care (help with everyday activities), which is the bulk of what assisted living provides.
Medicare may still cover related medical care while someone lives in assisted living, such as:
- Doctor visits and hospital care
- A short, medically necessary stay in a skilled nursing facility after a qualifying hospital stay
- Medicare-covered home health or hospice services when criteria are met
For free, unbiased help understanding Medicare, Medicare Advantage, Part D, and supplement plans, contact North Carolina's Seniors' Health Insurance Information Program (SHIIP), run by the NC Department of Insurance, at 855-408-1212.
