Medicare & Medicaid Changes in 2025: What Lancaster Families Should Know Before Choosing Assisted Living

When you're weighing assisted living or memory care in Lancaster County, PA, understanding what changed for 2025 can save you time, stress, and money. Below is a plain-English guide to the new numbers, what Medicare actually covers, how Pennsylvania Medicaid (Medical Assistance) works for long-term care, and fast ways to fund a move when safety can't wait.

2025 at a Glance: Key Medicare & Medicaid Facts

• 5-year Medicaid look-back applies. PA reviews 60 months of asset transfers when someone applies for Medicaid long-term care or HCBS/waiver services. Plan early to avoid penalties. Pennsylvania Government
• Pennsylvania Medicaid & the CHC program. For adults 21+ who meet financial and functional criteria, Community HealthChoices (CHC) is the managed-care program that coordinates long-term services and supports at home or in facilities. Pennsylvania Government
• Medicare still doesn't pay for room & board in assisted living. It covers medical needs (doctor visits, hospital, rehab) and short Skilled Nursing Facility stays (coinsurance $209.50/day after day 20; up to 100 days per benefit period)—but not custodial care in assisted living. National Council on Aging
• Medicare Part B costs rose in 2025. The standard monthly premium is $185 and the annual deductible is $257. Factor these into your monthly care budget.

Local tip: The Lancaster County Office of Aging can point you to benefits counseling and caregiver resources. lancoaging.org

What Medicare Covers vs. What It Doesn't (2025)

Covered (when medically necessary):

• Hospital stays, physician services, diagnostics

• Short-term Skilled Nursing Facility after a qualifying hospital stay (coinsurance after day 20 in 2025)

• Some home health and hospice

Not Covered:

• Monthly rent/room & board in assisted living (custodial care)

• Long-term personal care needs without a skilled component

Bottom line: Medicare won't pay for assisted living housing, so families often combine savings, long-term care insurance, VA benefits, or home equity to cover costs. 

Pennsylvania Medicaid (Medical Assistance) & CHC in 2025

If your loved one's care needs and finances qualify, Medicaid can help pay for long-term services via CHC. Highlights:

• Who can enroll: Adults 21+ who are dually eligible (Medicare + Medicaid), in certain waivers, or nursing-facility eligible. Pennsylvania Government

• Financial/functional tests: You must meet nursing-facility level of care and income/asset limits (e.g., 2025 reference: single nursing-home applicant income under ~$2,901/mo; assets under $2,000—programs vary, check your case). Medicaid Planning Assistance

• Look-back: Transfers within 5 years are reviewed and can trigger penalties. Get advice before gifting or retitling assets. Pennsylvania Government+1

• Timing: CHC waiver approvals can take weeks to ~90 days; start early. phlp.org

Action step: Call the Independent Enrollment Broker (IEB) listed in the CHC eligibility guide to begin the process and get a timeline. phlp.org

A Practical Funding Plan for Lancaster Families

1) Confirm Benefits & Costs (This Week)

• Call your top assisted living or memory care communities and get all-in monthly costs.

• Review your 2025 Medicare out-of-pocket (Part B premium/deductible) and medications. CMS

• If you may need Medicaid/CHC, speak with the Lancaster County Office of Aging and the IEB to understand eligibility and timing. lancoaging.org+1

2) Decide: Bridge Funding vs. Wait
If CHC approval is weeks away—or your loved one needs to move sooner—consider bridging the gap with home equity.

3) Unlock Home Equity Quickly (No Repairs Needed)
That's where Transitions Home Solutions comes in. When time and safety are the priority, we:

• Buy houses in Lancaster County as-is (no repairs, cleaning, or showings)

• Provide fair, all-cash offers with $0 commissions/fees and flexible closings to match move-in dates

• Can help coordinate clean-outs/donations, so you can focus on care

This approach puts funds in hand in 10–21 days (often faster), versus months of prepping and listing.

Quick FAQs

Does Medicare ever pay for assisted living?
No—Medicare covers medical needs and short SNF stays, not assisted-living rent or custodial care. National Council on Aging

How do we know if we qualify for Pennsylvania Medicaid/CHC?
You must meet financial and functional criteria and complete the CHC process through the IEB. Plan for documentation and a possible waiting period. Pennsylvania Government+1

What about the 5-year look-back?
Pennsylvania reviews 60 months of transfers for less-than-fair-market value. Penalties can delay coverage, so get guidance before moving assets. Pennsylvania Government

Talk with a Local Team That Moves at Your Speed

If rising 2025 costs and eligibility timelines are creating pressure, we can help you fund care without delays. Transitions Home Solutions serves Lancaster, Lititz, Ephrata, Mount Joy, Elizabethtown, and surrounding communities.

👉 Get a free, no-obligation consultation: transitionshomesolutions.com/contact
📞 Call: 717-715-0010

Key takeaway: With 2025 Medicare costs up and Medicare not covering assisted living, many Lancaster families rely on Medicaid/CHC and home equity. If safety can't wait, a fast, as-is sale can bridge the gap so your loved one gets the right care now.