Thursday, April 11, 2024

Does Medicare Pay For Assisted Living In Florida

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Monetary Benefits For Assisted Living Medicaid

New assisted living facility requirements after 10 residents die at Florida nursing home after Irma

Medicaid for assisted living or in-home benefits has its limitations. This Medicaid program does not pay for all of the assisted living facility’s cost, for instance, nor does it pay for 24/7 in-home care. In Florida, Medicaid will generally help with assisted living costs by reducing the by $1,100-$1,500/month. Medicaid does not pay for the room and board for the ALF, but only can pay for the medical portion. Practically, not every facility will apply the Medicaid subsidy the same way, so be sure to talk to the assisted living facility about what expected costs would be. If the elder has low income, for instance, the family may need to assist with assisted living costs. Our law firm could help protect assets above the bare minimum, which can happen even when the elder is already in the nursing home.

Relying On Annuity Income To Fund Long

An annuity is a contract between a person and an insurance company that is designed to meet retirement and other long-range financial goals. There are a few different types of annuities, each with different features, pros and cons. You may make a lump-sum payment or series of payments and, in return, the insurer agrees to make periodic payments to you. These disbursements may begin immediately or at some future date.

Annuities arent for everyone, but some seniors use these investments to turn their savings into a steady stream of retirement income that can be used to pay for assisted living and other long-term care services.

Read:The Pros and Cons of Using Annuities for Retirement Planning

Bypassing The Assisted Living Wait List

The best way to by-pass the wait list to get Medicaid benefits for the ALF is through the 60 day wait period when an elder is already in a nursing home. If the elder is already in the nursing home, we often take advantage of this opportunity to apply for and receive Medicaid, then transition the elder to assisted living with Medicaid’s financial assistance. Once the elder receives Medicaid and has been in the nursing home 60 days, the applicant will be able to leave the nursing home and go home or to assisted living with Medicaid’s financial support. We have some good information on questions to ask when your elder enters the nursing home. Veteran’s benefits may also assist the elder and the surviving spouse of a war time veteran. This process is tricky but if your elder is ever receiving rehabilitation in a skilled nursing facility, now may be the time to get Medicaid for him or her.

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Alzheimers And Other Forms Of Dementia

People with Alzheimers disease or other forms of dementia require varying types of services. Some may benefit most from adult day care, others from in-home care, and still others from residing in assisted living or skilled nursing facilities.

A person with Alzheimers disease or another type of dementia receives the same coverage as others using Medicare.

Medicare usually does not cover long-term nursing care, but some Advantage plans may provide coverage for this or custodial care.

Insurance providers can give more information about the dementia care coverage that specific Advantage plans offer.

Medicare pays 100% of the costs of hospice care. However, a copayment of $5 for prescribed pain relief medication sometimes applies.

Medicare does not pay for room and board when someone receives hospice care at home.

Hospice care is for people who are terminally ill. To qualify, a doctor must have confirmed that treatment would not be effective and that the person is not expected to live for more than 6 months.

Some situations can affect Medicare coverage. These include:

Observation periods

When a doctor is deciding whether to admit a person to a hospital, they may consider the person to be an outpatient. This time period does not count toward the criterion for skilled nursing care coverage that requires the person to have spent the last 3 days in a hospital.

Refusing care

If a person refuses care at a skilled nursing facility, they may lose coverage.

What Is The Difference

Alcime Assisted Living

Often people misunderstand the difference between Medicaid and Medicare. Although they both help senior and disabled citizens cover many health-related expenses, they are separate and very different programs.

Medicare is a type of health insurance for seniors, disabled individuals, or anyone with permanent kidney failure. Medicare is funded by Social Security tax contributions . Unlike Medicaid, Medicare is an entitlement program that most senior citizens enroll in at age 65.

Florida Medicaid is a needs-based program with benefits determined by the individuals financial and medical position.

Do Both Medicare and Medicaid Pay for Nursing Home Care?

With regards to long term care costs for our elder or disabled clients, Medicaid does cover nursing home care for applicants who meet the eligibility requirements for Medicaid coverage.

Medicare provides coverage for skilled nursing care in a nursing home however, this care is limited to 20 days of coverage. In certain circumstances, an additional 80 days may be partially covered. This is an important distinction between limited skilled nursing home stays and long term nursing home care coverage.

Here is a summary of the two programs:



  • Medicare is federally controlled, with uniform application in all 50 states
  • Skilled nursing care benefits through Medicare are as follows:
  • Up to 100 days of skilled nursing care are available per period of illness.
  • Recommended Reading: Can You Sign Up For Medicare Part B Anytime

    Memory Care Costs In Nearby States

    The $4,200 a month seniors pay in Florida for memory care is not only lower than the national average of $4,861, but it is also significantly less than the average in nearby Mississippi, where monthly costs average $4,229 for similar care. Other nearby states are competitive with Florida, such as South Carolina, where costs are also $4,200 per month. Memory care in Georgia and Alabama is somewhat less expensive than it is in Florida, at $4,002 and $3,900 per month, respectively.


    The Cost Of Memory Care In Florida

    Memory care generally costs 20 to 30% more in each state than the cost of assisted living in the same area, according to the Genworth Cost of Care Survey 2019. In Florida, where the average cost of assisted living is $3,500 per month, the typical cost seniors pay for memory care is $4,200. This is significantly less than the average cost of memory care nationwide, which is about $4,861 a month.

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    How Does The Wait List Work

    The HCBS wait list takes the sickest individuals first. Referrals are made to your local Aging Resource Center , such as this one in Pinellas County, who manages the wait list. It does not hurt to try to place your elder on the wait list if they are needing more and more help as they age. The elder does not need to qualify for Medicaid financially to be on the waitlist, importantly. If the elder comes off the wait list, you would likely see a good elder law attorney if the income/assets were over the bare minimum.

    If your elder is on the HCBS wait list, you would want to inform your Aging Resource Center of any change in health changes, falls, trips to the hospital, etc. Moving up the list likely means that the elder will need to be in a nursing home within the next 3 months, so a change in health may help him or her move up the wait list. A good elder law attorney can also be very helpful in moving the applicant up the wait list under as the attorney can help advocate while looking at the areas of health care priority. As in anything in life, an informed elder law attorney can be invaluable.

    Will Medicaid And Medicare Pay For Memory Care In Assisted Living Facilities

    Medicaid Financing and Coverage Issues in Assisted Living

    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.

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    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.

    Assisted Living Facility Requirements

    Florida ALFs must meet certain logistical requirements to ensure that residents live in a positive, accessible, and home-like atmosphere. The state allows facilities to provide either private apartments or single- and multiple-occupancy bedrooms within shared spaces. Both types of lodging require lockable doors, full-use kitchens, a minimum of square footage, and accessibility features for people with reduced visual and functional capacity.

    Private assisted living apartments must provide at least 80 square feet per resident. Multiple-occupancy rooms can accommodate no more than two residents and must have a minimum of 60 square feet of usable space per person. If a room is multiple-occupancy, at least 35 feet of living and dining space must also be provided per resident. Bathrooms may be shared, but at least one lavatory and one bathing area must be provided per every six and eight residents, respectively. In facilities licensed to provide Extended Congregate Care, bathing areas can only be shared by up to four occupants.

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    How Much Does Medicaid Pay For Assisted Living

    For many seniors, making the switch to assisted living can come with a host of challenges not the least of which is how to pay for it.

    After all, a private, one-bedroom apartment in an assisted living facility costs a median of $4,000 per month in the U.S., according to the Genworth Cost of Care Survey 2018 far more than the average social security check of $1,413 per month . Without savings, it can be difficult for seniors to afford assisted living services or facilities.

    Some states have Medicaid programs and other services to help seniors live more independently at home or in assisted living environments. But Medicaid is a joint federal and state-run program, and who can receive benefits, what it pays for and how to enroll varies from one state to the next.

    Ways To Pay For Assisted Livingvarious Options Are Available To Pay For Assisted Living

    What Will Medicare and Medicaid Pay For? A Guide for ...

    For older adults, paying for assisted living is a juggling act because the average income of a resident is $27,260 while the costs run close to $3,022 a month.

    Residents must tap additional resources to cover the cost, and the funds often come from the sale of their biggest asset: their homes. According to the same data, the average total assets for residents, including the home, is $431,020.

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    Florida Unitedhealthcare Assisted Living Plan

    UnitedHealthcare Assisted Living plans are Institutional Special Needs Plans for members who live in a contracted assisted living facility and require an institutional level of care. These plans do not require referrals for specialty care.

    • UnitedHealthcare Assisted Living Plan
    • UnitedHealthcare Assisted Living Plan

    Health Maintenance Organization plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies.

    Point of Service plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services – typically at a higher cost.

    Preferred Provider Organization plans work with a network of contracted local physicians and hospitals, but also allows members the flexibility to seek covered services from outside of the contracted network, usually at a higher cost.

    UnitedHealthcare offers Medicare Advantage Special Needs Plans that combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.

    Tools and Resources – UnitedHealthcare® Assisted Living Plan

    How Does Medicaid Pay For Assisted Living

    There are several ways Medicaid programs cover services provided in or by assisted living facilities, according to a spokesperson from the U.S. Centers for Medicare & Medicaid Services. The most common ways are through home and community-based services state benefits plans or special waivers.

    HCBS state plans

    HCBS state plans are entitlement programs open to everyone who qualifies for Medicaid in that state. Whats covered under these plans can vary pretty widely from one place to the next. For example, while nearly all states have state plans that cover home health therapies, case management and hospice care, only about a dozen offer plans that provide support for low-income seniors living in residential care facilities, or assisted living.


    Because Medicaid plans dont cover the full cost of assisted living, some states fill in the gaps by offering special waivers. These waivers can be more restrictive than state plan benefits and are typically given to particular populations, such as adults over 65 with limited resources who need nursing facility level care but who want to continue to live independently.

    That said, every state runs its waiver program a little differently. Waivers can be called by a lot of different names, cover different expenses and have different eligibility requirements. You can find the programs available in your area by reaching out to your local Council on Aging.

    Other state programs

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    The Senior Legal Helpline

    The Department of Elder Affairs maintains a helpline for seniors in need of advice regarding civil law. The helpline is free to use, and provides appointment scheduling to people over 60 years of age who wish to speak with a Florida legal professional over the phone. Services that the helpline provides include free legal advice and briefing, referrals to state and local regulatory agencies, and help finding legal council when court representation is needed.

    The Senior Legal Helpline can be reached by calling 895-7873. To find out more, visit

    Help When You Need It

    Living Your Best Life with Monica Ball and Virginia Medicare

    If your loved one needs long-term care, please do not hesitate to contact us for assistance, even if you do not live in the Tampa Bay area! We also offer free monthly seminars on Medicaid and asset protection planning. You may also want to read about the 7 lies your friends will tell you about Medicaid and elder law in Florida.

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    The Cost Of Assisted Living In Florida

    The average cost of assisted living in Florida is favorable in comparison to most surrounding states. At $3,500, Florida costs are on par with facilities in South Carolina and Mississippi, and are generally less expensive than facilities in North Carolina. The only southeastern states where assisted living is cheaper are Alabama and Georgia, where average income and costs of living are also lower.

    Costs of assisted living will vary in different regions of any state, usually skewing higher in more population-dense city centers. Cost variation in Florida can be significant, with the most popular cities for retirement, like Naples, being some of the countrys most expensive areas for assisted living. If Floridas most populated cities are excluded from the state average, the remaining counties have an average cost of only $3,000 per month.

    The type or level of assistance that is needed will usually affect an individuals costs for care. For example, in contrast to Floridas average costs of assisted living, nursing home prices in the state are extremely high, approaching $10,000 per month. Home healthcare and memory care services are likely to cost an average of $400 more than assisted living.

    How Are Care Levels Assessed

    Although the components of each level of care vary from facility to facility, there are some basic guidelines. Many assisted living facilities use a point system to determine a residents required level of care.

    No cost-of-care fee applies if the resident is considered independent and doesnt require any help. This can also apply to residents who only need verbal instructions to complete the activities of daily living .

    Residents who do require care are assessed prior to moving into the facility. The components that typically determine the level of care a resident requires are listed below.


    • Standing up from a seated position
    • Climbing stairs


    Residents who are able to manage their incontinence without assistance shouldnt have this service factored into the price of care.

    Residents who require help with their supplies will be charged.

    Higher levels of care include residents who exhibit behavioral issues around their incontinence for example, a resident who refuses to let aides change his or her diapers.

    It is common for facilities to price incontinence care according to an individual residents needs as a separate service.


    A resident who requires care from multiple caregivers simultaneously is likely to be assessed at a higher level of care.

    Some situations that would require multiple caregivers include:


    Residents who require eating assistance can fall into all levels of care.


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