Navigating Long-Term Care: Understanding Medicare’s Role in Assisted Living

Medicare programs have been a key part of senior care for nearly 60 years. There are several types of Medicare coverage, all of which support individuals in different ways. The 4 most common parts of Medicare are Part A, B, C, and D.

Original Medicare offers a combination of Part A and Part B. Individuals 65 and older who are already receiving Social Security, have End-Stage Renal Disease, or suffer from a disability are eligible for Original Medicare. Medicare Part C (Medicare Advantage) and Part D (prescription coverage) are also widely available.

Here is a more in-depth look into Medicare Parts A, B, C, and D.

Medicare Part A

In most cases, those eligible for Part A receive coverage for free. This is due to Medicare taxes they have paid for over time. Not everyone who receives Part A is exempt from a monthly premium

Medicare Part A supports those that require hospital insurance and other forms of in-patient assistance. This includes skilled nursing facility care, nursing home care, hospice care, and home health care. 

Medicare Part B

The other half of Original Medicare, Medicare Part B, covers other medical insurance needs. This includes:

— Home health services

— Ambulance services

— Health-related equipment 

— Preventative services like screenings and counseling

— Physical, speech, and occupational therapy

— X-rays and lab tests

— Mental health services and more

Medicare Part C

Medicare Part C is commonly known as Medicare Advantage. It often shares the benefits of Part A and Part B with a few additions and restrictions. Medicare Advantage Plans include access to vision, hearing, dental, and more, often making monthly premiums slightly higher than Original Medicare. Unfortunately, Part C may be slightly more restrictive if you travel or relocate to another state.

Medicare Part D

Medicare Part D helps beneficiaries afford prescription drug costs. It is offered by private insurance companies that are directly connected with the federal government. Those who qualify for Original Medicare can enroll in Medicare Part D.

Long-term assisted living is considered “custodial care.” Custodial care refers to helping someone with day-to-day tasks such as eating, housekeeping, bathing, and dressing. Unfortunately, Medicare does not pay for custodial care. However, Medicare can support seniors under certain conditions.

While Medicare can’t pay for assisted living costs, it may be able to support those in need of skilled nursing care. Medicare Part A can provide skilled nursing care within an assisted living environment. This may include specific types of therapy, like physical therapy.

It is possible to receive skilled nursing care in an assisted living facility, but it is quite uncommon. It is much more common to receive this sort of care in a nursing home environment. Medicare can also support individuals who need transportation to doctors’ appointments and other preventive health services. Unfortunately, without additional health insurance, residents in assisted living facilities are expected to pay out-of-pocket for services.

Although Medicare offers little financial support for assisted living, there are other important resources for those in need. Medicaid is the primary payer for the majority of long-term care services in the United States.

While Medicaid can offer major support for those needing assisted living, it does not cover room and board costs. Instead, it can support those in need by waiving certain expenses. These costs include food, bathing support, dressing, grooming, toileting, and medication management. Sometimes, Medicaid can waive fees for housekeeping services, social activities, and transportation.

Medicare Advantage and Supplemental Insurance
Medicare Advantage plans offer services similar to those of Original Medicare. This means that it does not directly cover assisted living expenses. However, with some Part C plans, certain expenses may be covered (meal delivery, transportation, and some daily living support).

Supplemental insurance like Medigap also falls under the branch of Medicare, which offers limited help for assisted living. However, it may help to relieve some out-of-pocket expenses for other forms of short-term care that may be required.

In today’s world, it can be difficult to save and plan for the future. With so much change and uncertainty, many adults do their best to prioritize their day-to-day needs first. However, failing to plan for long-term needs can lead to financial challenges down the road.

Long-Term Care Insurance and Advance Care Directives

Long-term care insurance and advance care directives are a great way to plan for your future. As we age, it can become increasingly difficult to care for ourselves physically, mentally, and emotionally. Instead of leaving difficult decisions for our families, we can handle difficult medical situations before they happen. 

Long-term care insurance refers to insurance that will support assisted living and other long-term care in the future. Rather than being trapped in spending thousands of dollars a month, long-term care insurance can mitigate that cost significantly. 

Advance care directives are legal documents that instruct health care professionals about how to properly care for you, particularly if you are no longer able to communicate.

Finding Assisted Living for You

There are over 30,000 assisted living communities in the United States alone. This can make it difficult to find the best one for you or your loved one. Here are some tips for finding a facility that meets your needs and budget:

— Make sure your insurance (long-term care insurance, veterans’ benefits, Medicaid, etc.) is accepted by the facility 

— Talk to the staff, residents, and resident family members about their experience

— Try the food

— Learn all out-of-pocket costs

— Explore all amenities in person

— Explore all safety and cleanliness measures

— Ensure that the staff has worked with people with your specific needs

— Make a list of questions for managers

For more information and support, seek personalized guidance from Medicare, Medicaid, and Long-term Care planning counselors and healthcare providers. Don’t try to navigate the world of health insurance all by yourself. Talk to an expert today. 

Benefits | Medicaid

Your Medicare Coverage | Medicare

What Is Long-Term Care? | National Institute on Aging (nih.gov)

It’s incredibly important to prepare for long-term care. Assisted living is a valuable resource for aging Americans. Medicare, Medicare Supplemental Insurance, and Medicaid can provide some support for seniors, but they cannot fully pay for assisted living support. 

Properly planning for long-term care, including finding good long-term care insurance, can be crucial as we age. Many resources are available for those seeking long-term support. And ultimately, researching all available resources while we’re young can help us greatly later in life.