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The older we get, the more help we need to take care of ourselves. Today, assisted living is a necessity for millions of Americans. These skilled nursing homes let seniors live independently while still giving them the help they need. Whether you’re looking for care for yourself or a loved one, there’s a lot to consider. And cost is one of the biggest factors.

In general, Original Medicare doesn’t cover the cost of long-term assisted living care. It’s made of two parts:

  • Medicare Part A (hospital insurance) pays for hospital stays and home health care.
  • Medicare Part B (medical insurance) covers doctor visits and outpatient care.

Original Medicare doesn’t include coverage for what’s known as “custodial care.” This refers to non-medical help for everyday activities (like eating and bathing) that most assisted living homes provide.

However, there are certain instances where Medicare will pay for skilled nursing care. Let’s take a closer look at what you need to know about Medicare coverage for assisted living.

What Skilled Care Does Medicare Cover?

Since assisted living isn’t considered a medical necessity, it’s not included in Original Medicare coverage. But some stays at skilled nursing facilities are covered. For example, short-term stays that follow an inpatient hospital procedure are typically covered under Medicare Part A. To be eligible for coverage, these requirements must be met:

  • Your hospital stay must have been at least three consecutive days.
  • You must be admitted to the nursing facility within 30 days of leaving the hospital.
  • Your doctor must certify that you need daily care or supervision from a skilled nursing or therapy staff

Some services that are performed in an assisted living home may also be included in your Part A coverage. This would include things like physical therapy or wound care. And if you've recently moved to an assisted living home, Medicare will keep covering the same services it did before your move. This would include services like:

  • Doctor appointments
  • Prescription medications
  • Medical equipment, like wheelchairs or oxygen
  • Wellness or fitness programs
  • Transportation to and from doctor’s appointments

If you’ve been diagnosed with a terminal illness, Medicare Part A may also pay for hospice care in an assisted living community if the following criteria is met:

  • Life expectancy is less than six months.
  • You are no longer seeking a treatment or a cure.
  • Medication is used only to control symptoms or pain.

Alternatives to Medicare Coverage

Assisted care can be expensive. In fact, the average cost of assisted living in the United States today is $4,500 per month – about $54,000 annually. That’s why it’s important to know more about options that can help ease the cost.

  • Long-term care insurance
    Long-term care insurance is just what it sounds like – a policy meant to cover the costs of long-term care not covered by Medicare or traditional health insurance. These policies can vary widely. Some may only cover nursing home care while others will pay for assisted living, adult day care and home health care.
  • Medicaid
    Medicaid is the federal health program that offers healthcare assistance to people with lower income and limited resources. Some states offer waiver programs that cover the costs of assisted living for eligible applicants. But the rules vary by state and some have long waiting lists to qualify.
  • Veterans benefits
    If you’re a veteran, you may be able to get assisted living benefits through the VA healthcare system. To see if you qualify, contact your local Veterans Affairs office.

Medicare Advantage may also help offset some of the cost of long-term care. Also known as Part C, these plans are offered by private insurance companies and include bundled benefits for things not covered in Original Medicare. And while a Medicare Advantage plan won’t cover room and board at an assisted living facility, some now include benefits related to long-term services, such as in-home patient support and adult day care. You may also be able to use your life insurance policy to pay for assisted living.

Alternate Long-Term Care Options

With the cost of assisted living facilities being relatively high, it’s important to know they’re not your only choice when it comes to long-term care. Some options you may want to consider include:

  • Community-based care services – Many communities have volunteer groups that can help with shopping and transportation. Adult day care, senior centers and meal delivery programs can assist with long-term care needs.
  • Subsidized senior housing – State and federal programs that help pay for senior housing are available for people with low to moderate income levels. Residents live in their own apartments and get help with meals, housekeeping and laundry.
  • Continuing Care Retirement Communities (CCRCs) – Some retirement communities offer increased levels of care, ranging from individual homes for residents to live on their own to assisted living for those needing higher levels of care.
  • Group living - These residential care communities offer group living arrangements with assistance for bathing, dressing and meals. Residents pay a monthly rent and additional fees depending on the type of personal care they receive.
  • PACE (Program of All-inclusive Care for the Elderly) – PACE is a Medicare/Medicaid program that helps people meet their health care needs, including adult day care and nursing homes.

Before you make any decisions about your long-term care, talk to someone you trust (like a family member or your health care provider) to understand your options. If you’re unsure about the long-term care benefits included in your Medicare Advantage plan, please contact a Wellcare team member. Our experts can help you identify long-term care coverage options that are right for you.

Assisted Living Coverage Questions

Does Medicare pay for home healthcare?

Yes, Original Medicare will cover part-time home health services as long as you’re “homebound,” which means:

  • You have trouble leaving your home without help due to an illness or injury.
  • Leaving your home isn’t recommended due to your condition.

What is the average cost for assisted living?

The cost of assisted living depends on where you live, the type of facility and the level of care you need. As of 2023, the average cost of assisted living in the United States is $4,500 per month, or $54,000 annually.

How much is long-term care?

The cost of long-term care depends on the level of care you need, where you live and the kind of assisted living facility you choose.

How much does a skilled nursing facility cost?

The cost of a skilled nursing facility depends on where you live and the individual facility. As of 2023, the average cost for a nursing home in the United States is $7,908 a month for a shared room and $9,034 for a private room.

 

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Sources

Medicare.gov - Nursing Home Care
Medicare Skilled Nursing Facility Care
Medicare.gov - Other Long Term Care Choices
National Council on Aging - Assisted Living Costs
VA.gov - Find VA Locations

 

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Y0020_WCM_134133E_M Last Updated On: 3/20/2024