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  • Medicaid, Medicare and Assisted Living – What Exactly is Covered?

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Medicaid, Medicare and Assisted LivingSeniors who live on their own often face unique challenges as they age. It can be harder to perform the tasks needed to maintain a home, and mobility may also become an issue. Many seniors will secure part-time help in the form of a home care aide, or their loved ones may step in to lend a helping hand as needed.

For many seniors, it is much easier to simply move to an assisted living community where they are able to live their golden years on their terms, but with help always at hand. Assisted living facilities are a helpful option for elderly citizens who are able to live independently but need a limited to moderate amount of assistance in order to thrive.

Assisted living communities differ from one location to the next, but they all offer the same basic range of services. In many cases, residing in an assisted living home is more affordable than living in a private home and hiring a caregiver separately. Depending on the location and level of care required, the monthly cost will range anywhere from $1,800 a month to as much as $7,500 a month. With such high costs of care, many seniors resort to the help of Medicaid and Medicare to cover the costs of assisted living. However, Medicaid and Medicare coverages for assisted living costs, just like the cost of assisted living, can vary from individual to individual depending on their income and other qualifications. In this guide, we will explore what kind of coverage Medicaid and Medicare provide when it comes to paying for assisted living.

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.

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 HMO’s that will cover additional senior services such as vision and dental care as well as cover the cost of their prescription medications.

Medicaid Coverage of Assisted Living

Those who have limited or low income are able to qualify for Medicaid. Seniors are able to hold both Medicaid and Medicare at the same time. For eligibility, seniors with their homes and very few other assets are considered. Medicaid is paid for by the state and the federal government jointly. This dual payment status is the reason why qualifying for Medicaid varies from place to place.

Medicaid programs run by the state will cover some of the costs that originate from assisted living expenses for seniors who qualify. But just like Medicare, it will not pay for the room and board for a senior in an assisted living community. Medicaid will pay for case management, nursing care, assessments, medication management and medical exams of a senior who is living in an assisted living facility.

Paying for Assisted Living with Medicaid and Medicare

Seniors will typically need to pay a deposit on top of their monthly fees for assisted living. There are several ways to pay for assisted living. Seniors may use long-term care insurance, self-payment, or even a community benefit. Although Medicare won’t cover the cost of assisted living care, Medicaid may cover some of the costs. Seniors are able to use a mix of payment options to pay for their stay and if eligible, state Medicaid will cover some of these expenses.

Medicaid pays fully for nursing home stays due to the fact that the caregivers provide skilled nursing and other medical-related services. With assisted living, there is not always a need for skilled nursing or even medical care. As a result, Medicare provided by the state is unable to pay for a senior's room and board directly and Medicaid is not required to pay for a senior’s stay in an assisted living home.

Assisted living communities offer rooms that cost approximately half of that of a nursing home room that is semi-private. States understand that offering assistance to seniors who opt to reside in an assisted living community over nursing home will save on Medicare costs in the long run.

Medicaid & Medicare Costs, Coverage & Details

As of the last update, 46 states and the capital were listed as providing at least some level of payouts to those residing in an assisted living facility. Some states, specifically Louisiana, Kentucky, Alabama, and Pennsylvania do not provide Medicaid coverage for seniors who reside in assisted living homes. Though Medicaid is not offered, these states have other non-Medicaid programs that seniors may avail to help pay for their long-term care costs.

Support types and levels vary greatly from state to state. However, states that are barred from offering direct Medicaid payments create other unique solutions for seniors. Some ways states assist seniors is by placing a firm limit on the number of fees a facility that is Medicaid certified may charge. Another is by offering seniors who are Medicaid-eligible supplemental assistance for their assisted living fees. Instead of these funds originating from Medicaid, they are taken out of general state funds to help pay for senior assisted living costs.

Another way many states help senior Medicaid recipients reduce the expenses of assisted living is by covering the fees of supplemental services offered by these communities. Assisted living supplemental services may include; personal care, medical assessments, coverage of nursing care, medication management, case management and medical exams. 

Alternative State Payments for Assisted Living Expenses

States offer a broad range of alternative coverage for seniors that are not part of the typical Medicaid program. These payments are provided through alternative programs that allow for the waiver of some federal rules such as income eligibility. Most seniors who apply for these waivers must exhibit care needs equivalent to a senior who lives in a nursing home in order to qualify.

Alternative payment programs also have a limited number of spots available, often significantly fewer than Medicaid. Because the waiting list is quite common and lengthy, many seniors will apply well in advance of their actual needs. Support programs differ from region to region and not all programs may be available to seniors statewide. Make sure to ask your enrollment officer about alternative programs available for their location when researching assisted living communities to join.

There are also other non-traditional assistance programs that are available for specific groups of seniors. For example, veterans or the surviving spouse of a veteran have special programs available to help defray the cost of assisted living. Many religious groups and organizations also offer funding for long-term care or have assisted living facilities for seniors that operate on a not for profit model.

How Can I Find an Assisted Living Community That Accepts Medicare or Medicaid?

As we or our parents grow older, the looming question of placing our elderly in an assisted living home inevitably presents itself. While some families choose to take care of their aging parents and relatives, it’s not always something every family can accomplish. It can be from lack of knowledge on how to take care of the elderly, or from issues of distance as we don’t always live next to or even in the same state as our parents and relatives as we ourselves grow older. Finding the right answer to the question of “how can I find assisted living near me that accepts Medicaid or Medicare?” can take time and prove to be a difficult task. What works for one family may not work for all families. Health issues, financial situations, and emotional attachments are just a few of the factors that should be taken into account before making a final decision.

Assisted living communities offer elderly care for patients that will need long term care or short-term assistance. Many care programs can also assist with memory support, and provide services that are tailored to assisting patients with Alzheimer’s or dementia. There are twenty-four-hour services, so you can be sure you’ll be getting the right support.

Finding an assisted living home is simple with our handy search tool. We have a range of search options that will help you locate the right facility for your budget and your needs. While some families are exclusively in need of an living assisted community, others would like to stay in the comfort of their own home and receive services. We have a multitude of options fit for any circumstance from help for the elderly, to the disabled and even those with memory impairments. At-home care can be costly, and not every family can spare the resources to afford it, however, there are publicly funded programs that are available which can help you pay for assisted living for the senior in your life. With that in mind, never let money stop you from making the decision to find the right assisted living community for you and your family needs.

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 Alzheimer’s 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. 

The Bottom Line for Using Medicaid and Medicare for Senior Living Costs

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 won’t 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.

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