At a certain point in life, some seniors move into assisted living facilities, housing for people who need help with activities of daily living (ADLs), such as bathing, dressing or taking medicines. They don’t need the skilled medical care provided in a nursing home, but rather the general assistance and personal care they might otherwise miss while living independently. Show
Assisted living is expensive, and since many seniors are enrolled in some sort of Medicare coverage (the federal health insurance program available to U.S. adults age 65 and older), you might wonder whether it covers this type of care. Here’s what you need to know about Medicare’s coverage of assisted living costs. Medicare does not cover the costs associated with residing in an assisted living community (which can also be referred to as custodial care). This type of care “is not considered medically necessary or a health insurance issue,” says Gabrielle Juliano-Villani, owner of Colorado In-Home Counseling, which serves seniors and disabled adults. Medicare only pays for long-term care if you require skilled nursing or rehabilitative services, and even then, Medicare only covers it for a certain duration. It does not cover non-skilled assistance with daily activities, which comprises the bulk of assisted living care. With that said, even if you move into an assisted living community, Medicare will continue to cover your prescription medications and/or other medical services that would have otherwise been covered by your particular plan if you still lived at home. Medicare Part A, which is hospital insurance, does not pay for assisted living. It covers:
Medicare Part B, which is medical insurance, covers:
Does Medicare Advantage Cover Assisted Living?Medicare Advantage plans, which are commonly referred to as Medicare Part C, don’t cover the costs associated with assisted living, either. However, there are thousands of Medicare Advantage plans available nationwide that are sold by private insurance companies, and each plan offers its own unique benefits with various costs. Does Medicare Supplement Cover Assisted Living?Medicare Supplement plans, also known as Medigap plans, are designed to cover the gaps left by Original Medicare coverage. Medigap plans are required by the Centers for Medicare & Medicaid Services (CMS) to provide standardized benefits nationwide, but premiums can vary from provider to provider. Similar to Medicare Advantage plans, Medigap plans don’t cover the costs associated with assisted living. How Much Does Assisted Living Cost?Assisted living costs an average of $119 a day, or $3,628 a month, according to the government’s Administration on Community Living. Juliano-Villani adds that assisted living facilities can “cost $5,000 per month, [and that’s] on the lower side.” Most people pay for assisted living out of pocket, with Medicaid (a federal and state program that provides free or low-cost health care to people with limited income or resources) or with private long-term care insurance. Some also finance it with reverse mortgages, life insurance options and annuities. Find Trusted Senior Caregivers On Care.com Care.com helps you find local caregivers ready to help with meal prep, bathing, companionship, transportation and more. How to Pay for Assisted LivingIf you don’t have significant savings to draw from to pay for assisted living, other options may be available to you. Veteran BenefitsAid & Attendance is a need-based benefit offered to eligible veterans by the U.S. Department of Veterans Affairs (VA). Received in addition to a VA pension, this monthly stipend may be used to cover the cost of a long-term care or assisted living facility. To be eligible for this benefit, a veteran must meet at least one of the following criteria:
MedicaidMedicaid covers some costs of assisted living for residents who qualify. Recipients must:
Benefits and requirements vary from state to state. Reverse MortgagesWith a reverse mortgage, a person borrows against the equity in their home. The most common type of reverse mortgage is a home equity conversion mortgage, which is only available to homeowners who are at least 62 years old. The home’s title remains in the homeowner’s name, and no mortgage payments are made over the life of the loan. Unlike a conventional mortgage, interest and fees increase the amount owed on the loan over time, thus decreasing the homeowner’s equity. The home must remain the principal residence of the borrower, so a reverse mortgage can only be used to pay for assisted living if there is a second borrower still living in the home. The loan is then repaid either by the homeowner or their heir(s) when the homeowner no longer lives in the home. What Are Other Care Options Covered by Medicare?Medicare Part A covers skilled nursing care, but only in certain conditions and on a short-term basis. It must be provided less than seven days a week or less than eight hours a day over a period of no more than 21 days, with some exceptions. Some of the other care options that might be covered by Medicare include:
Does Medicare Cover Assisted Living for Dementia?Medicare doesn’t cover the costs associated with assisted living for people with dementia. However, Medicare may help pay for other services related to dementia care, such as inpatient hospital care, physician fees, some medically necessary items and short-term skilling nursing care for up to 100 days, according to Medicare.org. If you or a loved one is admitted to an Alzheimer’s special care (or memory care) unit specifically, Medicare may cover some of the costs associated with that care. Certain hospice care, whether rendered in the home, a nursing facility or an inpatient hospice facility, may also be covered for people with dementia. People with dementia may be eligible to join the Medicare Advantage Value-Based Insurance Design (VBID) Model as well. This program gives enrollees with chronic conditions (such as dementia) additional benefits, reduced cost sharing and more flexible plans from Medicare Advantage providers. How to Enroll in a Medicare PlanIf you apply for retirement or disability benefits with the Social Security Administration, that application automatically serves as your application for Medicare, too. Otherwise, you’re first eligible to enroll in Medicare three months before and three months after you turn 65. If you miss that initial enrollment period, you may have to wait to enroll and pay a penalty when the time comes. Once you enroll, your Medicare coverage starts on the first day of the following month. Review Your Personalized Medicare Options With A Dedicated Advisor Your one stop shop for navigating Medicare and finding the benefits you are looking for. Get Started For Free How to Choose the Right Medicare Plan for YouNavigating Medicare plan options can be a daunting task. First things first, it’s helpful to understand the various parts of Medicare and how they differ.
You can enroll in Medicare Part B without Part A. However, if you buy Part A (or enroll for free), you must also enroll in Part B. If you want broader coverage for services not covered by Part A and Part B, you can also consider:
The Medicare plan (or plans) you choose should suit your specific medical needs, future health care expectations and budget. If you’re interested in the Medicare Advantage and Part D routes, know that plans vary widely by state, so it’s important to explore what Medicare Advantage plans are available in your particular area. Meanwhile, Medicare Supplement plans are standardized in the benefits they can offer and mainly differ in terms of monthly premium rates. Frequently Asked QuestionsWhat home health care is covered by Medicare?Medicare does cover home health services deemed medically necessary for those who meet eligibility requirements. According to Medicare.gov, covered services can include:
Meanwhile, Medicare doesn’t cover:
Does Medicaid cover assisted living?Medicaid can help cover the costs of assisted living depending where you live and which specific Medicaid assistance you receive. Currently, 47 states and Washington, D.C. offer some measure of Medicaid assistance for people in assisted living, though other states may offer similar services in a different setting (such as home health assistance). Check with your local Medicaid office to see if you qualify for assisted living support. Can you get financial assistance for assisted living?Applying for Medicaid is likely your best bet for financial assistance with assisted living costs, but the benefits you can get depend on where you live and your eligibility for specific aid programs. Otherwise, older adults can seek assistance from certain nonprofit organizations or charities that provide such services. Veterans (and widows of veterans) are also eligible to receive assisted living benefits. How is most assisted living care usually paid for?Most families use private funds to pay for assisted living. This means a combination of personal savings, pension payments, and retirement accounts. Though many seniors save for retirement over the years, family members often contribute to elder care costs.
Who qualifies for assisted living in Alabama?Who Is Eligible? Applicants must be 65 years of age or older, be blind or disabled, have limited income and resources, and meet certain citizenship requirements. Some applicants can apply online via the Social Security Administration website. Others must visit their local SSA office for in-person assistance.
Do assisted living facilities in PA accept Medicaid?Assisted living facilities, called "personal care homes" (PCHs) in Pennsylvania, are generally less expensive and less medically intensive than nursing homes. PCHs are licensed by the state, but in general, Pennsylvania's Medicaid programs do not cover the costs of PCHs.
Does Medicaid pay for assisted living in Washington state?Assisted Living Medicaid Policy
Washington is one of the few states where Medicaid directly covers the cost of assisted living facilities for eligible seniors. Certain facilities are directly contracted by Apple Health to provide care to older adults who qualify.
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