Can I Use Medicare For Assisted Living For My Parents
Assisted living communities are a fantastic option for helping to care for elderly parents. Unfortunately, assisted living communities can also be expensive. A 2019 Genworth Cost of Care Study found that the average monthly cost for assisted living is $4,000 nationwide. Thatâs just for baseline care: for example, seniors who have Alzheimerâs or dementia can expect to pay an additional $800-$1,200 a month.
When looking for long-term care for elderly parents, many individuals wonder if there is Medicare for assisted living. After all, it would appear at first blush that Medicare should also cover the costs of care that are provided within assisted living facilities. The truth, unfortunately, is not so simple.
But Medicare is primarily for medical expenses that require skilled professional care. Because there isnât Medicare for assisted living coverage, finding financial assistance for assisted living can be difficult.
Using A Reverse Mortgage To Pay For Assisted Living
An older adult who owns their home outright or has only a small mortgage can convert some of the equity in their home into cash payments while still retaining ownership. While there are different types of reverse mortgages, federally insured Home Equity Conversion Mortgages are the most common. When it comes to paying for residential senior living , reverse mortgages are usually only an option if the institutionalized elders spouse, or another individual who is a co-borrower on the loan, still resides in the home and maintains it per the terms of the loan. Otherwise, the loan becomes due when the last borrower no longer lives in the house for 12 consecutive months, sells the home or dies.
What About Medicare Advantage
Medicare Advantage must cover at least as much as Original Medicare. But since Medicare Advantage is private insurance contracted through the government, the specific benefits of each policy are unique.
That said, Medicare Advantage doesnt typically cover assisted living or any other long-term custodial care, although it continues to cover your eligible medical expenses like prescriptions, surgery, doctors appointments, screenings and equipment if you move to an assisted living facility. It may also provide some additional benefits such as transportation to your medical appointments, vision and hearing coverage and gym memberships.
Also like Original Medicare, your costs may be covered if you need short-term care at a skilled nursing facility immediately following a hospitalization.
Recommended Reading: What Is The Best Medicare Advantage Plan In Texas
Taking Out A Bridge Loan To Help Pay For Assisted Living
Bridge loans are a risky option that should be used with caution. A bridge loan is a short-term loan that may be appropriate for seniors whose financial situations are not currently conducive to a move to long-term care.
For example, it is common for an elder to sell their home and use the proceeds to fund their move to assisted living. But, if their care needs suddenly become too urgent to wait until the house sells before moving to assisted living , this plan can unravel. For people affected by conditions out of their control, a bridge loan, typically for 6 to 12 months, may be a viable option for temporarily funding their care. In this case, the senior assumes that their home will sell within the length of time specified in the contract for a sum that will cover repayment of the loan.
Will Medicaid Pay For Assisted Living
Medicaid typically pays for some but not all assisted living services. Families and seniors can expect help with costs related to medical treatments and personal care services, reducing their overall bill. However, Medicaid often wont cover the total price of room and board in an assisted living community. In most states, Medicaid can be used to pay for the following:
- Help with ADLs like toileting, mobility, and dressing
- Home health services, which may be provided in an assisted living community
- Physical, occupational, or speech therapy
Don’t Miss: Does Medicare Cover Wheelchairs And Walkers
Will Medicaid And Medicare Pay For Memory Care In Assisted Living Facilities
Any care that is medically necessary for a person who suffers from dementia or Alzheimers disease is covered by Medicare. However, Medicaid / Medicare will not cover the cost of living in a memory care facility, custodial care, or a memory patient’s personal care. What is covered is any stay in a hospital, hospice care and skilled nursing with a limit of 100 days consecutively. Medicare will also cover the cost of preventative care for a person who suffers from a memory condition. This can include medical equipment, doctors appointments, physical therapy, and diagnostic testing. Overall, though, Medicare will not cover the cost of a room in an assisted living facility, but a senior can use Medicare to pay for memory-related treatments and services received while staying in an assisted living community.
Medicaid will pay for memory care in any facility that has a contract to offer Medicaid services. Some of these may include specialized assisted living homes, or they may be separate wings inside of a nursing care facility. For any independent long-term care home, assisted living community, or memory care facility, Medicaid will cover the services listed in the assisted living section we have listed earlier in the article.
What Is The Difference Between Home Health Care Services And An Assisted Living Facility
| Home health care services | Assisted living facilities |
| Home health care services are provided in your home by skilled medical professionals who are operating in accordance with physicians orders. Home health care services are limited in scope and short-term in duration. The goal of these services is to restore you to your previous level of functioning after an illness or injury or at least help maintain your level of functioning or slow your decline.
Medicare covers medically necessary home health care services. Federal and state entities regulate home health care, which is provided through Medicare-certified home health agencies. |
ALFs are residences geared toward housing people who are unable or unwilling to be at home, but dont require skilled care.
Medicare does not cover ALFs. ALFs are governed by state rules and regulations and may be Medicare and Medicaid certified. ALFs provide a lower level of care, and are thus less expensive, than nursing homes. |
Recommended Reading: How To Know If I Have Medicare
Is Assisted Living Considered Inpatient Care
In most cases, assisted living is not considered inpatient care, which is why its not covered by Medicare Part A. Following a qualifying inpatient hospital stay, Medicare covers a stay in a skilled nursing facility for up to 100 days, after which the patient is responsible for 100% of the costs. In some cases, skilled nursing services may be provided in an assisted living facility. In this instance, these services would be covered by Medicare Part A and Medicare Advantage.
What Are Your Long
As a Medicare beneficiary, you have these basic rights:
- To safety when you get health care
- To get the health care services the law says you can get
- Protection against unethical practices
- Protection of your privacy
If you receive LTC in a nursing home or facility, you have rights and protections under federal and state law as a resident, including the right to:
All states must have a long-term care Ombudsman program. An ombudsman serves as an advocate for residents and helps to resolve problems or violations of rights. Residents and family members can ask LTC administrative staff about how to contact their local ombudsman.
Also Check: How To File A Medicare Claim As A Patient
Whos Eligible For Medicare And Medicaid
The requirements are going to be similar, but they are going to be state-specific, McDowell says in regards to Medicare and Medicaid eligibility markers.
Heres an overview of federal guidelines:
- Medicare recipients must be age 65 or older. Individuals receiving Social Security or Railroad Retirement Board benefits are also eligible, along with people whove received Social Security or Railroad Retirement Board disability benefits for at least two years. Kidney transplant patients and people undergoing kidney dialysis treatment are also eligible. The Social Security website is a resource that can help seniors review requirements and start the Medicare application process.
- Medicaid recipients must meet certain income thresholds and asset limitations based on their state of residence. Though income requirements vary in each state, theyre typically based on being within 133% of the poverty level. States can also deem individuals medically needy, meaning they exceed the standard income but have significant medical expenses. If your family member is planning to apply for Medicaid, its a good idea to contact your state medical assistance office for more details. Depending on where you live, Medicaid programs may be referred to as auxiliary grant, elderly waiver, or frail elderly waiver programs.
Do Medicare Advantage Plans Help With Assisted Living Facilities
As mentioned above, Medicare Advantage plans typically dont cover custodial care in an assisted living facility, but they often offer additional benefits. For example, Medicare Advantage plans usually offer prescription drug coverage, and might offer coverage for routine vision, dental, and hearing services. Some plans even include membership in Silver Sneakers fitness programs. Please keep in mind that you are still responsible for your Part B premium if you choose to enroll in a Medicare Advantage plan.
If you need help understanding Medicare coverage and your assisted living options, Im available to answer your questions. Click one of the links below to schedule a phone call or request an email with information prepared just for you. You can check out plans in your area by clicking the Compare Plans button.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Also Check: When Can A Person Born In 1957 Get Medicare
Applying For Va Benefits To Pay For Assisted Living
The U.S. Department of Veterans Affairs offers pension funds to some eligible wartime veterans who have low income and limited assets. The Aid and Attendance benefit is an increased monthly pension that many veterans and their families do not know about. This higher pension amount is awarded to eligible veterans and surviving spouses who require the assistance of another person to perform activities of daily living , such as bathing, dressing, toileting and feeding. Assisted living facilities provide these kinds of personal care services.
In 2021, an eligible veteran may receive up to $1,936 monthly, a surviving spouse with no dependents is eligible for up to $1,244 monthly, and a veteran with a non-veteran spouse is eligible for up to $2,295 monthly through the A& A pension program.
For more information on this and other VA benefits, what these programs cover, eligibility criteria and how to apply, download AgingCare.coms FREE Veterans Benefits eBook.
Does Medicare Cover Memory Care
Much like with assisted living, Medicare wont pay for rent or board in memory care facilities. However, Medicare does cover many costs associated with dementia treatment, such as equipment and supplies designed to counter common dementia safety risks. Seniors with dementia generally experience a loss of balance and coordination in the early and middle stages of the disease, and Medicare pays for resources like walkers and grab bars.
Under some Medicare Advantage plans , families can receive cost assistance with GPS trackers for elderly loved ones, devices which help avoid the dangers of wandering and disorientation either in a community setting or at home.
Medicare Part D, which provides prescription drug coverage, also assists with common dementia care costs. Though theres no FDA-approved medication known to cure Alzheimers or other forms of dementia, Medicare Part D helps pay for medications that may stave off the conditions progression.
Recommended Reading: Do You Have To Apply For Medicare
How Do I Choose A Custodial Caregiver
Choosing a caregiver for your loved one is probably the easiest step in the entire process. You can hire a custodial caregiver on your own or you can hire an agency to locate one on your behalf. Sometimes, assisted living facilities will offer their own staff to fill in the role of a custodial caregiver if your loved one is already a resident.
Regardless of how you choose to locate a custodial caregiver, you will need to look over their qualifications and conduct an interview. Medical care is not a part of a custodial caregiver role, however if you find a person who has additional medical training, then consider it a bonus.
Make sure to ask for references for prior jobs in the same field and make sure that you follow up with those references. It is a good idea to run a background check on anyone you plan to hire. If possible, conduct the interview with the caregiver with your loved one present. It is important that the personalities of your loved one and the caregiver match in order to create a cohesive and trusting relationship.
Read Also: How Can I Pay My Medicare Bill Online
How To Pay For Assisted Living With Medicare
Funding Assisted living can be a challenge since Medicare doesnt cover this type of care. The specific insurance for coverage would be a long-term care policy. But those plans arent always the easiest to obtain and maintaining them can be even more challenging. Some experts suggest you could fund assisted living through a reverse mortgage, life insurance policy, or an annuity. Although, even those ways of funding have pros and cons.
Also Check: Is A Chiropractor Covered By Medicare
Modifications To Improve Home Safety
People often move into assisted living after they have had afall or more difficulty getting around their own home. With this in mind,Advantage plans will now be able to offer installation of wheelchair ramps andbathroom safety grab bars. Other examples would be special air conditioners forpeople with breathing disorders.
The hope is that if more people are able to afford thesekind of home improvements, that there will be fewer medical emergencies and elderlyindividuals might be able to continue living at home for a longer period oftime before assisted living becomes necessary.
Recommended Reading: Sterling Court Assisted Living St George
Long Term Care Benefits
Medicare is the primary medical care insurance for a large number of seniors. Many are shocked to discover that Original Medicare , also called Traditional Medicare, does not cover costs for most types of long term care, including Alzheimers and dementia care. When it does pay, it is only in a very limited capacity. While Traditional Medicare is not a long term care solution, there are benefits for seniors with recoverable conditions on a short term basis. Also, as mentioned previously, some Medicare Advantage Plans now offer some home and community based long term care benefits under specific circumstances.
Skilled Nursing FacilitiesMedicare will pay for 100% of the cost of care up to 20 days at a skilled nursing facility and approximately 80% of the cost up to 80 more days. The care must be for recovery following an inpatient hospital stay.
Assisted Living CommunitiesMedicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care or the room and board cost of assisted living. Some Medicare Advantage plans may pay for personal care assistance for persons residing in assisted living or memory care, but will not contribute towards the cost of room and board.
Adult Day CareOriginal Medicare does not pay for adult day care services, but some Medicare Advantage plans may cover the cost.
Read Also: Does Medicare Cover One Touch Test Strips
Best Long Term Care Insurance Of 2022
Get the latest reviews on the country’s top long term care insurance services. We rate the best Long Term Care services to give you a better look into what each company offers.
- Best for ages from 50-69 years
- Established in 1976, A+ Rated
- Nations leader in Long-Term Care insurance
- We also specialize in Short-Term Care, Critical Care, and Life/LTC Hybrids
- Access to all companies to compare quotes
- Monthly Cash Benefits are paid when home care is provided by spouse, family or friends
- Planning Today for a Secure Tomorrow
- Receive quotes from an ample selection of insurers
- Find the plan that’s best suited to your needs
- Average premiums round out at $200 a month, but there are options for $100/month available.
- Best for ages from 50-69 years
- Established in 1976, A+ Rated
- Nations leader in Long-Term Care insurance
- We also specialize in Short-Term Care, Critical Care, and Life/LTC Hybrids
- Access to all companies to compare quotes
- Monthly Cash Benefits are paid when home care is provided by spouse, family or friends
- Planning Today for a Secure Tomorrow
Where Can I Find Custodial Care
There are many assisted living communities for seniors in most urban and metropolitan areas that offer custodial care. Some retirement communities are set up in scenic locations to ensure elderly people can remain close to nature, while others are located deep in the heart of the city. Whatever your custodial care needs may be, when you are planning on moving your loved one into a senior assisted care facility, the availability of custodial care will always play an important role in the selection process.
Finding which community works best for you can be as easy as making a few phone calls and visiting the centers that have all the services that you need and seek. Taking into account the environment of each community can also help narrow down the search. Are you looking for an assisted living center that is easily accessible, and next to the metropolitan areas, or perhaps would like a community away from the city in more rural and quiet areas located outside of town? These are a few questions to ask yourself when searching for senior assisted living homes that offer custodial care.
Our directory offers a wealth of information regarding custodial care, general senior care, memory care and much more for the seniors in your life. We are happy to help you choose an option that works best for you and your loved one that also fits their individual needs.
Dont Miss: Is Viberzi Covered By Medicare
Recommended Reading: What Age Is For Medicare
