Wednesday, July 17, 2024

Does Medicare Medicaid Cover Assisted Living

Don't Miss

Who Is Eligible For Medicare Advantage

Does Medicaid Pay for Home Care or Assisted Living Care?

Medicare Advantage plans are available to seniors age 65 and over who are either enrolled in Original Medicare or are eligible to do so. To be eligible, seniors must be legal U.S. citizens or legal residents and have lived in the country for at least five consecutive years. Additionally, they must live within their plans service area.

Medicaid For Pennsylvanians Needing Home Health Care

Home health care can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning. Pennsylvania has several programs that offer payment for home care services.

First, if you receive Medicaid, the program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you.

Does Medicare Or Medicaid Cover Assisted Living & Memory Care Facilities

As the cost of healthcare continues to rise, you may wonder how you or your loved one will keep up with their medical cost. On average, the cost of living in an assisted living community is just under $45,000 per year, per senior. Elderly people who need more intensive care, such as that provided in a nursing home can cost as much as $90,000 a year for each senior. Retirees and seniors who need specialized memory care facilities can expect their cost to fall in the middle of those two, at around $65,000 a year per senior.

Understanding the cost involved with assisted living is the best way to plan ahead for the future. When planning for long term care, it is also important to understand which services are covered or excluded by Medicaid and Medicare.

Don’t Miss: How Do I Check On My Medicare Part B Application

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.

The Bottom Line For Using Medicaid And Medicare For Senior Living Costs

Do Medicare and Medicaid Pay For Assisted Living ...

It is common knowledge that the cost of living in an assisted living community can stretch a family’s budget, even to the breaking point. Unfortunately, the alternative is to allow seniors to live in an environment that is lacking the much-needed assistance required for them to thrive. Over time, the cost of spot treatments for accidents, declining health and in-home assistance will often surpass the cost of living in a monitored facility.

Though Medicaid and Medicare wont cover all of the costs associated with moving to an assisted living home, it can cover many of the supplementary services associated with it. These programs not only will pay for medical cost but in some cases, they can pay for part of the stay at a residential long term care facility such as an assisted living home. Every state has different rules that regulate eligibility, so it is critical that you speak with your State Medical Assistance Office for more information.

Other resources that seniors can use to help pay for assisted living expenses can be found in your local Area on Aging department or other programs. Many assisted living communities will offer guidance from case managers and intake workers to help you navigate the Medicaid/Medicare process.

Also Check: What Age Do You Draw Medicare

Pennsylvania’s Medicaid Resource Limit

To qualify for Medicaid in Pennsylvania, you must also have few resources, or assets. The resource limit for individuals whose income is below 300% of the FBR is $2,000 for an individual, but the program also “disregards” $6,000 in assets, so you can actually have up to $8,500 in resources and still qualify. The resource limit for an individual whose income is above 300% of the FBR is $2,400.

Some property does not count toward the resource limit. In Pennsylvania, your home is exempt up to an equity value of $572,000, so long as you live in it, intend to return to it, or if your spouse or dependent lives in it. One vehicle is also excluded from the resource calculation.

What Are My Other Long

You may have other long-term care options available to you. Talk to your family, your doctor or other health care provider, a person-centered counselor, or a social worker for help deciding what kind of long-term care you need.

Before you make any decisions about long term care, talk to someone you trust to understand more about other long-term care services and supports like the ones listed below. You might want to talk to:

  • Your family
  • Your doctor or other health care provider
  • A person-centered counselor
  • A social worker

If youre in a hospital, nursing home, or working with a home health agency , you can get support to help you understand your options or help you arrange care. Talk to:

  • A discharge planner
  • A social worker
  • An organization in a “No Wrong Door System,” like an Aging and Disability Resource Center , Area Agency on Aging , or Center for Independent Living

American Indians and Alaska Natives can contact their local Indian health care providers for more information.

Recommended Reading: What Medications Are Covered By Medicare

Medicaid Waivers May Cover Assisted Living Costs

Low-income seniors may be eligible for Medicaid, a program that offers additional support for those who cant afford the cost of Medicare deductibles and premiums. Medicaid covers more long-term care services than Medicare, but the scope of coverage is determined at the state rather than the federal level.

Many states offer Home and Community-Based Services waivers to provide assistance with personal care, housekeeping and other assisted living services. Most HCBS waivers dont directly cover room and board, but Medicaid-eligible seniors may be able to qualify for other state-funded programs that help with these costs. Local agencies, such as Area Agencies on Aging, often provide free long-term care options counseling to help seniors and their families find ways to pay for assisted living.

How Optional State Social Security Supplements Work

Does Medicare cover residential assisted living?- Gene Guarino – Residential Assisted Living Expert

Read this section before going to your states policy.

Optional State Social Security Supplements are complicated and confusing. However, families caring for an aging loved one, need not understand every nuance. In a simplified view, OSS can help seniors pay for assisted living by providing money for assisted living room and board costs.

For persons who are financially eligible, states, through their Optional State Supplements, provide assistance to help pay for the room and board fees associated with assisted living or adult foster care. The benefit is provided as additional money over and above the amount they receive from Social Security SSI. However, the individual does not receive the money directly. Instead, it goes directly to their assisted living community or adult foster care home. Depending on ones state, the amount of assistance can range from insignificant, just a few dollars per month to over $1,000 per month. Though mentioned previously, it should be re-emphasized that the actual OSS amounts are calculated based on the individuals income. The table below shows a breakdown of how the Maximum OSS is funded in a sample state that has a Maximum OSS for room and board of $1,200.

Also Check: Does Medicare Cover Dupuytren’s Contracture

Medicaid Coverage Of Assisted Living Services In North Carolina

Assisted living facilities are generally less expensive and less medically intensive than nursing homes, but are not cheap by any means. Most North Carolina residents living in assisted living facilities pay their own costs. Generally speaking, Medicaid does not cover room and board fees in assisted living facilities. However, if you have little income and few assets, you may qualify for a program that helps pay for assisted living facilities.

If you receive SSI and live in an assisted living facility, you may qualify for a benefit called Special Assistance that will pay for room and board expenses, up to $1,182/month, at adult care homes . People with dementia who live in specialized care units can receive more money each month . You will also recive a $46 per month personal needs allowance.

If you don’t receive SSI, your income must be lower than $1,229 per month and you must have less than $2,000 in countable assets . Those seeking to live in special care units must have income less than $1,561 per month.

A separate program, called Special Assistance In-Home , provides a similar benefit for low-income people who could reside in an assisted living home but want to stay in their own homes. To apply for SA or SA/IH, contact your local county Department of Social Services office.

The Basics Of Medicare Advantage

In contrast to Original Medicare, which is provided by the federal government and offers the same coverage at the same cost to every beneficiary, Medicare Advantage plans are provided by private health insurance companies. While these plans are legally required to provide the same coverage as Original Medicare Parts A and B, many plans offer additional benefits like dental and vision coverage and non-medical in-home care services, making them an attractive option to many retirees.

Also Check: Does Medicare Cover International Medical Emergencies

Will Medicare Cover Assisted Living Costs

Mockaitis Law Group LLCSept. 25, 2019

When you are in the process of estate planning, it is important to make provisions for where and how you will live if you find yourself unable to take care of your own daily needs. People are living longer and longer these days, which is a good thing, but it can also make end-of-life planning more stressful. Many people are planning to rely on Medicare to help them cover any necessary assisted living costs as they age. However, according to, Medicare does not pay for the majority of long-term or personal care services.

Medicare will only pay for stays in skilled nursing facilities under specific conditions. Medicare will pay for this if you were in the hospital for at least 3 days, and then were admitted to a Medicare-certified nursing facility within 30 days of that hospital stay. Finally, your doctor will need to specifically say that you need skilled care of some sort.

If you meet these requirements, Medicare will cover the cost of being in a nursing home for up to 100 days in various portions. However, if you simply need assistance in your everyday life, Medicare will not pay for assisted living services.

Basically, Medicare will cover nursing home services in the event of an emergency or acute condition. You should not factor Medicare into your estate planning processes.

It is important to sit down with a professional and ensure that you will have access to the assistance you need during your golden years.

Why Would I Need Long

Does Medicare / Medicaid Cover Skilled Nursing?

Reasons for needing long-term care include:

  • Age. The older you are, the more likely you will need long-term care.
  • Gender. Women outlive men by about 5 years on average and so they are more likely to live at home when they are older.
  • Disability. Having an accident or chronic illness that causes a disability. 69 percent of people age 90 or more have a disability.
  • Health status. A chronic condition such as diabetes or high blood pressure makes you more likely to need care.
  • Living arrangements. If you live alone, youre more likely to need paid care than if youre married or living with a partner.

You May Like: What Does Medicare Part B Include

Does Medicare Cover Any Long

Medicare pays for long-term medical needs, but not personal care or assisted living costs. Medicare coverage does include limited nursing home care and temporary rehabilitative services. In the United States, 12.7% of seniors have a disability, 6.9% are veterans, and 5.2% receive Supplemental Security Income . These seniors have access to resources including community programs, veterans benefits, and medical programs available to SSI recipients.

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.

Read Also: Can You Get Medicare If You Retire At 62

When A State Can Recoup Benefits

After the Medicaid recipient dies, the state can try to recoup whatever benefits it has paid out. The home is usually the only major claimable asset. Currently, the state can only put a lien on it if it is part of the deceased’s probate estate. If the asset is jointly owned with a spouse or in a life estate or trust, then it can escape recovery.

In most states, the government can place a lien on the home after the death of both spouses, unless a dependent child resides on the property.

What Is Medicaid And What Does It Cover

Does Medicare Pay for Assisted Living or Home Care?

Medicaid is a federal insurance program administered by each state and jointly funded to cover the basic healthcare needs of lower income families. To qualify for Medicaid coverage, an individual must make less than 133% of the federal poverty line, which is about $16,000 per individual. Medicaid approval is based on financial need.

Although Medicaid and Medicare are clearly different. Some seniors may qualify for both if they are very low income, and over the age of 65. Because each individual state government administers Medicaid, they have leeway in how this program is implemented. To be reimbursed by the federal government, each state must offer qualified participants certain mandatory benefits that include:

  • Inpatient hospital services
  • EPSDT: Early and Periodic Screening, Diagnostic and Treatment services
  • Nursing facility services
  • Federally qualified health center services
  • Laboratory and X-ray services
  • Transportation to medical care

Medicaid assistance for assisted living changes by state. Because each state has considerable latitude within the federal government guidelines, each state can set policies regarding how they assist individuals residing in assisted living communities. Because benefits vary by state, we recommend that families review their states specific Medicaid information for clarity. Also, many assisted living communities do not accept Medicaid, so you will want to ask the communities that you are touring about their policy.

Don’t Miss: What Are The Four Different Parts Of Medicare

Medicare Coverage Of Assisted Living

Medicare is not a free full-service medical plan, but rather a subsidized form of medical insurance for citizens who are at least 65 years old. In most cases, it will cover medical care, however most long-term living costs such as retirement homes, independent living communities and assisted care facilities will not be eligible. What Medicare will cover is any short term stay by a senior in a skilled nursing home, a rehabilitation community and even home-based care provided by a licensed therapist or nurse. There are also some HMOs that will cover additional senior services such as vision and dental care as well as cover the cost of their prescription medications.

How Much Does Long

The cost of assisted living and other types of long-term care vary widely according to the level of care services you need and where you live. National averages include:

  • Expect to pay around $3,700 per month for a one-bedroom unit in an assisted living community
  • A semi-private room in a nursing home costs around $6,900 per month
  • You’ll pay around $7,700 per month for a private room in a nursing home
  • A home health aid costs between $20 and $25 per hour
  • Adult day care costs around $70 per day

Certain conditions usually lead to higher healthcare costs. For example, patients who require memory care due to Alzheimer’s disease or dementia usually have to pay more.

Most people who require long-term care receive it in their own homes, with a loved one providing care. They may also have a home health aide or someone who provides respite care for the primary caregiver.

Also Check: Does Medicare Part D Cover Shingrix

What Are My Options


Indiana offers Medicaid Home and Community-Based Services waiver programs that allow qualified individuals who otherwise would require care in a nursing home to remain in their own home, apartment or in an assisted living facility. To get further information about HCBS waiver programs, start with your Area Agency on Aging. Our interactive map shows which communities accept the waiver, those communities can help you determine whether you qualify.

Veteran Benefits

Veterans and surviving unmarried spouses of veterans may qualify for a benefit that helps cover the cost of assisted living. If you think you might qualify, talk with the assisted living community you are considering, they can help you get started or, visit Federal Benefits for Veterans and Dependents or check out the VAs benefits fact sheets. Also, download ALFAs Veteran Affairs Tool Kit with information on eligibility requirements.

Senior Living Care Insurance

Private Pay

When you consider assisted living, make sure you understand what is covered in the fees that you pay and then compare those costs to your current living situation. You may find assisted living is more affordable than you thought! And make sure you talk with your financial planner about your options!

For more information on benefits, visit Federal Benefits for Veterans and Dependents or check out the VAs benefits fact sheets.

More articles

Popular Articles