It seems like a simple question: Does Medicare pay for assisted living? But it can be surprisingly confusing to sort through all the details.
As adults, one of the most important decisions we’ll eventually face is ensuring the well-being and care of our aging parents.
When exploring the various options available, assisted living communities often emerge as an attractive choice. However, understanding the financial aspects can be overwhelming, especially when it comes to Medicare.
To make matters worse, we see and hear a ton of misinformation floating around on this topic. This bothers us! For such a tender and important time of life, we want you to have the facts so you can make the best decision for your family.
So in this article, you’ll find a clear overview that answers two of our most-asked questions here at Benton House:
- Does Medicare pay for assisted living?
- Besides Medicare, what financing options are available for assisted living?
Let’s explore this topic to help you make informed decisions and find the appropriate support for your aging parents.
Does Medicare Pay for Assisted Living?
First, what is Medicare?
Medicare is a federal health insurance program primarily designed to support individuals aged 65 and older, as well as those with certain disabilities or conditions. It consists of different parts, each with its own coverage and rules.
So does Medicare pay for assisted living? Short answer: probably not.
This is largely because Medicare does not cover “custodial care,” which refers to support with daily life tasks like eating, bathing, or dressing. This type of tender loving care makes up the bulk of what assisted living communities typically provide.
However, there are some associated assisted living costs that Medicare may cover. Let’s examine the specific components of the program to break this down.
Medicare Part A:
Medicare Part A covers hospital stays, skilled nursing facility therapy cost, hospice care, and some home health care. However, it does not typically cover the costs associated with assisted living facilities. Part A generally focuses on medical care rather than long-term care, which is the primary service provided in assisted living communities.
In short, Medicare Part A rarely, if ever, covers assisted living costs, but will cover most doctor visits, hospital stays, some needed special medical supplies, therapy costs, and other outpatient needs such as home health nursing services.
Medicare Part B:
Medicare Part B covers outpatient services, doctor visits, preventive care, and medical supplies. Similar to Part A, Part B does not pay for the costs of residing in an assisted living community. It is primarily aimed at medical services that are provided on an outpatient basis.
In short, Medicare Part B rarely, if ever, covers assisted living costs, but will cover most doctor visits, hospital stays, some needed special medical supplies, therapy costs, and other outpatient needs such as home health nursing services.
Medicare Advantage (Part C):
Medicare Advantage plans (Part C) are private insurance plans approved by Medicare. They offer additional coverage beyond what Original Medicare (Part A and Part B) provides.
Some Medicare Advantage plans may offer limited coverage for assisted living services, but it varies depending on the plan and the state. It’s crucial to review the specific details and limitations of each plan.
In short, Medicare Advantage (Part C) sometimes covers assisted living costs.
Medicare Supplemental Plans:
Last, you can consider Medicare Supplement plans (Medigap) for your senior loved one, which can help cover out-of-pocket expenses associated with Original Medicare. However, Medigap plans do not typically cover assisted living costs.
In short, Medigap rarely covers assisted living costs.
Alternative Options for Assisted Living Financial Support:
As you can see, Medicare usually does not cover assisted living costs directly.
So what are your other options when it comes to helping finance your senior loved ones’ care? Let’s take a look at the top five alternative avenues we suggest exploring.
Medicaid
Medicaid is a joint federal and state program that offers assistance for low-income individuals with limited resources.
Medicaid eligibility varies by state, so it’s essential to understand your state’s specific guidelines.
Long-Term Care Insurance
If your senior loved one has a long-term care policy, it may offer benefits to pay for assisted living services. At Benton House, we are happy to work with you to provide the necessary paperwork to submit to your loved one’s insurance company for approval.
These kinds of private policies vary in coverage, so if you’re considering signing your parents up for a long-term care policy, it’s important to carefully review the terms and conditions before purchasing.
Veterans Affairs (VA) Benefits
If your parent is a United States veteran or the surviving spouse of a veteran, they may qualify for the Aid and Attendance Program and receive monthly benefits to help cover the cost of the care.
This pension program is specifically designed to assist veterans and their spouses with long-term care needs, including assisted living.
Companion Living
This is an affordable option for individuals looking for cost savings while still enjoying all the services and amenities that are offered.
Companion Living can also smooth the transition to the community by providing an opportunity to build a close friendship.
Tax Deductibility
Did you know the Internal Revenue service provides a deduction for medical expenses? Eligible deductions include the cost of care in a nursing home, personal care home, or assisted living community if the primary reason for being there is to receive medical care. We encourage you to consult your tax advisor for a more detailed description of eligibility requirements. Find out more at www.IRS.gov.
Paying for Assisted Living: You Have Options
To wrap this up: Medicare does not usually pay for assisted living, but there are many alternative options to explore, from long-term care insurance to Veterans Affairs benefits.
We hope this article helps reduce any overwhelm about how to help finance assisted living costs for your senior loved one.
Would you like personal, customized help navigating Medicare and other financing options?
Get compassionate and tailored support from us in one of these three easy ways.
Visit our support page to request your complimentary Caregiver Workbook.
Call our Caregiver Hotline for free custom support at 855-461-2552. We’re here to help.
Send us a message describing how we can support you. Choose whether you’d like us to reach out: text, email, or snail mail.
There is no charge for these services. They’re simply an extension of our mission to help every family who calls.
