October 26, 2020

Can I Use Medicare for Assisted Living for My Parents?

Assisted living communities are a fantastic option for helping to care for elderly parents. Unfortunately, assisted living communities can also be expensive. A 2019 Genworth Cost of Care Study found that the average monthly cost for assisted living is $4,000 nationwide. That’s just for baseline care: for example, seniors who have Alzheimer’s or dementia can expect to pay an additional $800-$1,200 a month.

When looking for long-term care for elderly parents, many individuals wonder if there is Medicare for assisted living. After all, it would appear at first blush that Medicare should also cover the costs of care that are provided within assisted living facilities. The truth, unfortunately, is not so simple.

But Medicare is primarily for medical expenses that require skilled professional care. Because there isn’t Medicare for assisted living coverage, finding financial assistance for assisted living can be difficult.

What Medicare Pays For in Assisting Living (and What it Doesn’t)

Medicare covers a substantial range of medical treatments, medications, and other costs related to short- and long-term care. But there are still plenty of treatment options that aren’t included. Unfortunately, assisted living facility costs are one of them. If you were hoping to use your parents’ medicare plan to offset the cost of assisted living, you won’t be able to.

There are several reasons why Medicare doesn’t cover assisted living facilities. The primary reason is that Medicare considers assisted living communities as custodial and personal care facilities, rather than hospitals or other medical service providers. Since many of the services that assisted living facilities provide do not require skilled medical professionals, they are not included in Medicare Part A or B coverage.

There is hope, however, for those who are looking to use Medicare for assisted living costs, but with a caveat. Medicare covers assisted living costs relating to medical expenses, which can help when a resident needs specific medical treatment. These types of costs are considered in-home Medicare health services, and are therefore different than the living expense payments that aren’t covered.

If you or your loved ones are concerned about financing long-term care, there are options aside from Medicare and personal savings. To understand more about your care-related financial needs, use our cost of care tool.

Understanding Medicare’s Long Term Care Coverage

Medicare may not cover assisted living expenses aside from medical treatment, but that doesn’t mean that other kinds of long-treatment are also left out of coverage. In fact, there are a host of other long-term care options that are covered under Medicare, albeit not all of them are a fit for those who are in assisted living facilities that are not in need of ongoing medical care.

Inpatient Care in a Hospital

Medicare will cover inpatient hospital care if:

  • The patient is admitted after an official doctor’s order for an illness or injury
  • The hospital accepts Medicare insurance
  • The Utilization Review Committee approves the patient’s stay under certain circumstances

Keep in mind that your doctor may recommend services in the hospital that are not covered by Medicare. You’ll want to find out which services you may have to pay the costs. Check with Medicare’s Inpatient Hospital Care Coverage to fully understand your benefits.

Skilled Nursing Facilities Care

Skilled nursing facility (SNF) care is nursing or therapy that requires supervision or performed by technical personnel. Medicare Part A will cover SNF care for a limited time if:

  • There are days left to use in your benefit period
  • You qualify for a hospital stay
  • The SNF is Medicare certified
  • Your doctor recommends daily skilled nursing care or therapy
  • You need services for a hospital-related medical condition or a condition that started while in the SNF, like an infection

You’ll want to learn more about SNF Medicare coverage before deciding if this is the long-term care you want for your elderly parents.

Nursing Home Care

Medicare will cover nursing home care as long as it is for more than custodial care. Custodial care is unskilled professional help with daily living activities, like eating or dressing, or personal needs. Your parent must have a medical reason for needing nursing home care to be covered.

You’ll want to learn more about Medicare’s nursing home care coverage before deciding on a Medicare-certified facility.

Hospice Care

Medicare covers hospice care if your parent has been certified as terminally ill by their doctor, and you accept comfort care instead of fighting the illness. Your parent will also need to sign a statement for choosing hospice over other Medicare-covered treatments.

If your parent is terminally ill, you may want to consider your Hospice Care Medicare coverage.

In-Home Health Care

Medicare Part A and B both cover in-home health care services. Services that are eligible for coverage are:

  • Part-time skilled nurse care or home health aide services
  • Physical therapy
  • Occupational therapy
  • Speech Pathology services
  • Injectible osteoporosis drugs for women
  • Medical social services

Medicare will not cover custodial, personal care, homemaker, or meal services. Learn more about the in-home health services that Medicare covers.

How Much Do Medicare Advantage Plans Cover for Assisted Living?

Some Medicare Advantage (MA) programs cover personal care assistance costs and other supportive services found in assisted living communities. These are usually supplemental benefits that come with higher Medicare Advantage premiums. How much money your parents will receive depends on the MA plan your parents have.

How Can I Pay for Assisted Living?

When there isn’t Medicare for assisted living, you’re left to scramble for ways to help pay for your parents’ assisted living expenses. Here are some programs that can assist with the cost:

Medicaid

In forty-four states, Medicaid pays for some assisted living costs through different Medicaid programs like managed care programs and Medicaid Waivers. The individual will receive a small allowance for personal needs, and then the rest of the Medicaid assistance will go toward assisted living costs.

Veteran Affairs Aid and Attendance Benefits and Housebound Allowance

If your parents are veterans, they may qualify for assistance through Venteran Affairs programs. The VA Aid and Attendance Benefit and Housebound Allowance can help pay assisted living costs of $1800 a month for a single veteran and $2200 a month for a married couple.

Reverse Mortgage

If your parents own their home, they may want to use a reverse mortgage to pay for assisted living expenses. These are cash loans that don’t need to be repaid until your parents sell their home or the last borrower dies.

Long Term Care Insurance

Long Term Care Insurance policies purchased while your parents are in their fifties or sixties will cover assisted living expenses. Unfortunately, only about 5% of Americans buy these plans.

Social Security and Retirement Plans

While Social Security is a retired living allowance, your parents can use it to pay for assisted living expenses. The Social Security Benefits Calculator can help determine your parents social security allowance if they don’t know how much they receive.Also, if your parents have a 401K Retirement plan, they can use those funds to pay assisted living expenses.

Using Medicare for Assisted Living: The Bottom Line

Although Medicare doesn’t cover assisted living, there are other programs and plans to help with assisted living expenses. If you need to use Medicare for long term care, you may want to explore the other options that are covered such as skilled nursing facilities, nursing homes or at-home health services. By talking with your parents, you’ll be able to find a solution to meet any budget.

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