Do Medicare Plans Pay for Assisted Living? Everything You Need to Know

NEW YORK, December 15, 2020 (Newswire.com) - ​Assisted living can be a great solution for seniors that need some help with daily life, but want to maintain a high level of independence. Unfortunately, it can also be a major expense, costing tens of thousands of dollars annually. What’s more, unlike skilled nursing care in a nursing home, assisted living costs aren’t covered by Medicare.

Here, we’ll further break down what you can and can’t expect to be covered when it comes to assisted living between Medicare, Medigap or Medicare Advantage plans.

Medicare, Medigap, and Medicare Advantage

Original Medicare plans doesn’t cover assisted living facilities. However, while there’s no coverage for room and board or personal care, medical care received at an assisted living facility can be covered just as it would be in a doctor’s office or hospital.

Medigap policies are supplements to Original Medicare that help fill in coverage gaps. However, Medigap plans also don’t cover long-term elderly care, including assisted living or memory care. Medigap may do more to cover skilled nursing home and hospice care than Original Medicare.

Medicare Advantage plans are alternatives to Original Medicare that are offered by private companies. They include all the same coverage as Original Medicare, but often include additional coverage such as vision or dental insurance. Medicare Advantage plans vary in regard to what they cover beyond Original Medicare. Beginning in 2019 these plans were allowed to provide coverage for “daily maintenance” benefits, such as the kinds of personal care provided at assisted living facilities. That means it may be possible to look for a Medicare Advantage plan that will cover some portion of assisted living expenses.

Financing assisted living with Medicaid

Many seniors are able to get financial assistance for assisted living through Medicaid programs in their state. For those who qualify, this aid may come through Medicaid Waivers or a Medicaid managed care model, depending on how your state administrates Medicaid. Both options should provide some level of benefit for assisted living.

Some states restrict which residential facilities qualify for support through Medicaid, so people considering this route should make sure their facility of choice aligns with Medicaid guidelines.

Many states also have separate programs that can help people afford assisted living either through cash assistance or providing affordable living facilities managed by the state. These additional tools can be helpful in making assisted living accessible if it would otherwise be financially out of reach.

Figuring out how to pay for assisted living

If you’re having trouble coming up with a financial plan to make assisted living viable, there are people that can help. Professionals such as Public Benefits Counselors and Eldercare Resource Planners can help you navigate the local resources and organizations available to find out what makes the most sense for your needs. While you may have to pay a fee to consult with an Eldercare Resource Planner, it can easily be worth it for a knowledgeable guide to state, federal, charitable and other resources that could help you live a supported and rewarding life.

Source: iQuanti, Inc.