Many seniors reach a point where although they may need some help, they still prefer to continue living in their homes. If that ‘s the case with you, do you know if Medicare pays for assisted living or nursing home expenses?

For some seniors, they may eventually need help with some basic personal tasks of normal life but without the need for medical care. For seniors in this situation, an assisted living facility will likely be the better housing option.

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Many seniors reach a point where although they may need some help, they still prefer to continue living in their homes.

Assisted Living Facilities (communities) provide various non-medical services that can accommodate the daily needs that seniors need help with as they age.

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Does Medicare Pay for Assisted Living Expenses?

Medicare will not cover the expenses associated with living in an assisted living facility or community (also known as custodial care). Medicare does not consider custodial care as “medically necessary” and as such, it is not considered a health insurance issue.

Medicare will, however, cover some of the costs of long-term care if the patient requires skilled nursing care or rehabilitative services, but even then, only for a limited duration.

Medicare will not cover the costs of non-skilled assistance with a senior’s daily activities which are typically provided by an assisted living facility.

How Much Does Assisted Living Cost per Month?

According to ConsumerAffairs.com’s Assisted Living Statistics 2022, about 2% of U.S. seniors are living in an assisted living facility and are charged about $4,300 per month on average.

Most Assisted Living Facilities or communities offer several packages that include different levels of care which can impact your specific monthly expenses.

Here is a typical list of Personal Services and Lifestyle Services offered in an Assisted Living Community:

Personal Services

  • Assistance with daily needs like bathing and dressing
  • Help with moving around the community for meals and activities
  • Assistance with personal scheduling for physician appointments
  • Help with transportation or ambulance services
  • Assistance with taking meds prescribed by your physician

Lifetstyles Services

  • Meals that are based on a resident’s nutritional requirements
  • A wellness program consisting of healthy activities
  • Regular laundry and housekeeping services
  • Transportation to and from cultural and social events
  • Yoga classes and low-impact exercise services

Are there other Assisted Living Payment Options?

While Medicare, Medigap, or Medicare Advantage do not pay for assisted living expenses, there are other assisted living payment options available to seniors.

Private Long-Term Care Insurance

Many long-term care insurance plans will cover assisted living expenses however, your benefits will vary depending on the actual policy you purchased.

Medicaid

Since Medicaid is a combined federal and state-administered program, your eligibility requirements to enroll and the benefits Medicaid will cover depend on the state each senior resides in.

Additionally, seniors can not receive more than 100% of the Federal Poverty Level ($1,073 per month in 2022 for an individual) in retirement income to qualify for Medicaid.

Life Insurance

Many life insurance policies contain an “accelerated death benefit” which provides for the insurance company to advance the insured a large portion of the death benefit if you must live permanently in a nursing home, require long-term care, or be diagnosed with a terminal, critical or chronic illness.

The advanced death benefit will then be deducted from the death benefit when the insured person dies.

PACE

Many states have Programs for All-Inclusive Care for the Elderly which is a Medicare program that offers care services to seniors who would otherwise be confined to a nursing home. This state-administered program allows most eligible seniors to continue living at home rather than in a skilled nursing facility. To learn more about the benefits available from PACE, call them at (877) 267-2323 or go online to pace4you.org.

Veterans

Former military members and their spouses may qualify for this VA Aid and Attendance pension benefit to get help with paying for assisted living facility expenses. Visit VeteranAid.org to apply for assistance.

Does Medicare pay for Nursing Home Expenses?

Medicare will not pay for custodial care received in a nursing home, but it will pay for “skilled nursing care” received in a nursing home. Custodial care is similar to care in an assisted living facility where you get help with tasks of daily living like grooming, dressing, eating, hygiene, toileting, and walking.

On the other hand, skilled nursing is care that a senior needs for treatment or care that can only be provided by a licensed nurse.

Typically, skilled nursing includes:

  • Administering medications prescribed by a physician
  • Physical therapy provided by a licensed rehab team member
  • Occupation therapy
  • Speech therapy

The qualifications to have Medicare cover skilled nursing services are:

  • Must have Medicare Part A have days remaining in your benefit period
  • Must have a previous qualified stay in the hospital
  • A physician must certify that you need daily skilled nursing care
  • Your care must be given at a skilled nursing facility
  • The facility where you get care has to be Medicare-certified
  • You require skilled nursing services for a hospital-related condition or a condition that began while you were in a skilled nursing facility while getting care for the original hospital-related health condition

How to Get Help with Medicare Out-of-Pocket Expenses

Although Original Medicare can leave beneficiaries with significant out-of-pocket expenses because of deductibles, copays, and coinsurance, seniors can get help with those expenses from Medicare Supplement Plans and Medicare Advantage.

A Medicare Supplement (Medigap) will supplement Medicare by filling in the gaps caused by deductibles, copays, and coinsurance.

A Medicare Advantage Plan (Medicare Part C) will help with out-of-pocket expenses by filling in the Original Medicare gaps but also offering prescription drugs, dental, hearing, and vision coverage.

Although Original Medicare can leave beneficiaries with significant out-of-pocket expenses because of deductibles, copays, and coinsurance, seniors can get help with those expenses from Medicare Supplement Plans and Medicare Advantage.

A Medicare Supplement (Medigap) will supplement Medicare by filling in the gaps caused by deductibles, copays, and coinsurance.

A Medicare Advantage Plan (Medicare Part C) will help with out-of-pocket expenses by filling in the Original Medicare gaps but also offering prescription drugs, dental, hearing, and vision coverage.

Whether you are shopping for a Medicare Supplement Plan or Medicare Advantage plan that will help you reduce  your out-of-pocket healthcare expenses, look to a national health insurance broker that represents all of the highly-rated Medicare insurance providers so that you can take advantage of one-stop-shopping.

My Medicare Insurance Plan is a national Medicare insurance broker who will advocate for you and help deliver an insurance plan that will best meet your needs and budget. Since we are not employed by any insurance company, we can deliver the plan that will best me your needs.

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