Does Medicare Pay For Assisted Living

Does Medicare pay for assisted living

Many people have asked the question; does Medicare pay for assisted living.  The answer to this question differs depending on the type of Medicare coverage you have.

Original Medicare:

Medicare A & B (Original Medicare) does not cover the costs of assisted living.  Because assisted living is not considered medically necessary, it is not covered by either Part A or Part B.  Although, Medicare will provide coverage for approved short-term stays in skilled nursing facilities after inpatient hospital stays. Once the patient has reached 20 days in skilled nursing, there is a $200 a day coinsurance charge.  After 100 days, the beneficiary is responsible for 100% of the cost.

Original Medicare does cover some home health care services as well as hospice care.  Although Original Medicare does not cover assisted living, it does cover all approved medically necessary services under Parts A and B.  This includes hospital stays, medical procedures, screenings and visits to the doctor.

Medicare supplement plans:

Medicare supplement plans are used with Original Medicare. In general, they help cover the deductibles, co-pays and co-insurance that remain after Original Medicare pays its portion. It is in place to supplement Original Medicare.  Therefore, it does not cover assisted living or long-term-care.

Medicare Advantage Plans:

Medicare Advantage plans provide the same coverage as Original Medicare, Parts A and B.  MAPD plans are offered through private health insurance companies.  Most of these plans include prescription drug coverage as well as additional benefits.

Medicare Advantage plans do not cover assisted living costs. However, there are some plans that cover specific services that are similar to assisted living facilities.  These services may include providing coverage for assistance with the activities of daily living, such as transportation to doctors’ appointments and even meal delivery.

Assisted living coverage for dementia patients:

People who have dementia, are eligible for help from Medicare to pay for hospital stays, home health care, skilled nursing home care, hospice care, cognitive assessments and necessary medications. Some eligible patients with Alzheimer’s and dementia may receive payment assistance for care planning. Original Medicare does not provide payment for dementia care however, both Medigap and Medicaid may provide help paying for it.

Ways to pay for assisted living:

The cost of assisted living varies greatly depending on where you live and what the facility provides as well as what each individual requires in terms of care.

1.  One of the best ways to pay for assisted living is through a long-term care policy.  Unfortunately, by the time most people think about it, they are older may not be easily affordable for most individuals. If you are fortunate enough to purchase it while you are young enough that the prices are reasonable, there are many options to choose from.  Look carefully at all the rules and conditions before choosing a policy.
2.  Some people have the foresight to put a large sum aside for such instances.  You may have access to funds from savings, pensions of other sources.
3. Many states provide Medicaid waiver programs that can help pay for medication management, on site therapy or support services in a residential setting.  Medicaid does not pay for the cost of room and board.
4. Eligible veterans may receive assisted living benefits through their local VA.  This benefit may also be available to veterans through some approved non-VA facilities.
5. One more option is through funds obtained through a reverse mortgage.  Unfortunately, if you stay in an assisted living facility for over a year and your home is vacant, the reverse mortgage has to be paid back, this is often done by selling your home.  It is best to speak with a qualified financial counselor before taking this step.