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Does Medicare Pay for Assisted Living?

Does Medicare Pay for Assisted Living?

Does Medicare pay for assisted living? It’s an important question. After all, choosing the right care for yourself or a loved one is never easy. It’s a decision filled with emotions, concerns, and often, uncertainty. When it comes to assisted living, the financial aspect can add another layer of complexity to an already overwhelming situation.  So, it’s understandable that you’re checking out financing options. 

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Medicare is one of the most common health insurance programs for seniors. However, there are often limitations to its coverage. In this article, you’ll discover whether or not Medicare can provide some coverage, specifically for assisted living. 

Key Takeaways

  • Medicare generally does not cover the cost associated with assisted living facilities as it’s considered non-medical custodial care.
  • However, Medicare may cover medically inclined care such as screenings, skilled nursing care, or prescription drugs if you’re eligible.
  • Other funding options for assisted living include using your home equity, applying for Medicaid, or getting a long-term care insurance plan. 

Does Medicare Pay for Assisted Living?

Medicare generally does not cover the cost associated with assisted living facilities. This is because assisted living is often considered non-medical custodial care. This means that it primarily assists with activities of daily living such as bathing and dressing, rather than skilled medical services. 

However, Medicare is a health insurance program that focuses on covering medically necessary services such as hospice stays, doctor visits, and certain home health care services.

But even when you live in an assisted living facility, you might need some medically inclined care which Medicare can help cover. 

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What Part of Assisted Living Does Medicare Cover?

Living in an assisted living facility is sometimes more than custodial care. Sometimes you may have to go for screenings, require skilled nursing care, or even get prescription drugs. In cases like that, Medicare can provide coverage if you’re eligible. 

There are two basic ways you can receive Medicare; Original Medicare and Medicare Advantage. Original Medicare consists of Medicare Part A and Part B, each with its coverage services. Some of the services Original Medicare covers include; 

If you require any of the services above while living in an assisted living facility, Medicare can provide coverage. 

The second way to get Medicare — Medicare Advantage, encompasses the Original Medicare and some extra benefits. They’re offered by private companies that are approved by Medicare. The package might also come with Medicare Part D which offers prescription drug coverage. 

Like Original Medicare, Medicare Advantage doesn’t cover assisted living. But you can contact your plan to find out what services you can get coverage for while living in the assisted living facility. 

What Part of Assisted Living is NOT Covered?

Medicare does not pay for the following in assisted living:

  1. Housekeeping
  2. Community involvement
  3. Bathing 
  4. Dressing
  5. Meals
  6. Laundry
  7. Dining choices
  8. Exercise and wellness programs
  9. Medication management

Essentially, Medicare will not cover any service that isn’t medically inclined or necessary for your health. 

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Who Qualifies to Have Medicare Pay for Assisted Living?

It’s important to state here again that there’s no direct coverage under Medicare for assisted living. You have to be getting any of the services Medicare covers (listed above) to get any Medicare coverage while in an assisted living facility. 

To be eligible for these Medicare-covered services, you must be 65 or older, a U.S. resident, or someone who has legally lived in the U.S. for at least five years. 

What if Medicare Won’t Pay for Assisted Living?

You might be disappointed about the limitations of Medicare for assisted living. But don’t lose hope yet. There are other options for funding that you can explore. Here are some of them: 

Medicaid

Medicaid is just as popular as Medicare. But Medicaid is often available to everyone, regardless of age, as long as they meet certain financial criteria. 

Medicaid can provide coverage for some aspects of assisted living, but the extent of coverage varies from state to state. Some states offer Medicaid waivers or home and community-based services (HCBS) programs that provide coverage for certain assisted living services. 

These waivers or HCBS programs may cover personal care services, assistance with activities of daily living, and some medical services for eligible individuals residing in assisted living facilities. However, there are often eligibility requirements based on income, assets, and level of care needs.

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Since requirements vary from state to state, check with your state’s Medicaid program or local Medicaid office to determine the specific coverage options available for assisted living services in your area. 

Veteran Benefits

If you’re a veteran, you might qualify for assistance with the cost of assisted living through the Department of Veterans Affairs (VA). Here’s what you need to know:

  1. Coverage under VA Health Care: Some assisted living services (as well as some other adult care)  are covered under your standard VA health benefits if you’re enrolled in VA health care. However, you may still be responsible for copayments for certain covered services.
  2. Eligibility Criteria: To be eligible for these VA benefits, you must meet the following requirements:
    • You need to be enrolled in VA health care.
    • The VA must decide that you need a particular service to assist with ongoing treatment and personal care.
    • The required service or space in the care setting is available near your location.
    • The VA may also consider factors like your insurance coverage or service-connected disability status.
  3. How to Access Services: You can find out more about accessing these services by contacting your VA social worker or calling the toll-free hotline at 877-222-8387. The hotline is available Monday through Friday, from 8:00 a.m. to 8:00 p.m. ET.
  4. Applying for Benefits: If you’re not currently enrolled in the VA health care program, you can apply for benefits now to explore available assistance options for assisted living care.

Long-Term Insurance Care

Long-term care (LTC) insurance is an insurance plan that helps you pay for long-term care services. Unlike Medicare, there are no age restrictions on who can get this insurance program. Anyone can, as long as you can buy the plan. However, some people can be denied LTC if they have certain health problems.  

If an insurer grants you an LTC plan, here are some assisted living services your insurance is likely to cover: 

  • Personal care activities such as bathing and eating
  • Therapy 
  • Skilled nursing care

To get the full scope of the coverage details, it’s best you contact your insurer. 

Home Equity

Home equity is the value of your home minus any mortgage or loans you owe on it. If your home is worth more than what you owe, you have equity. There are a few ways you can tap into this equity to fund living in an assisted living facility. 

  • You can choose to rent your home and direct some of the funds to your assisted living expenses
  • You can also decide to sell your house. This option might be a problem if you intend to pass your home as an inheritance or go back to living in the house. 
  • Another option is termed reverse mortgage. It’s a loan that allows you to convert part of the equity in your home into cash. You can use this cash to pay for assisted living expenses.
  • The last option available is taking a home equity loan (home equity line of credit). A home equity loan is a loan you can take using your home equity as collateral. 

FAQs about Medicare and Assisted Living

Health care coverage can be confusing, so it’s naturally to have questions. Here are a few questions we’ve received about this service.

Does Medicare Pay for Assisted Living for Dementia?

No, Medicare does not cover assisted living expenses. But Medicare will come through if the dementia patient requires any Medicare-covered service like occupational therapy. 

How Can I Pay for Assisted Living with No Money?

If you’re a veteran (or the spouse/dependent child) of a veteran, you might be eligible to get aid for assisted living from the Department of Veterans Affairs (VA). Otherwise, you can use your home equity to secure funding for your assisted living needs.

Relief Recap

So, does Medicare pay for assisted living? While you may expect Medicare to cover some of the costs, it offers limited coverage for non-medical expenses. Fortunately, there are other options available and we explored many of them in this post.