5 Facts on Medicare and Assisted Living

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5 Facts on Medicare and Assisted Living

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There are many questions that people tend to have when it comes to a potential move of a senior into an assisted living community, and some of these naturally tend to revolve around costs and how they will be covered. One particularly common such question: Will Medicare pay for assisted living? 

At Cozy Retire, we’re here to provide a caring, compassionate assisted living community for families around Ogden, Layton and Kaysville, plus to provide important financial information ranging from basic room rates to coverage options and more. Here are some basics on whether Medicare covers assisted living costs depending on which Medicare program you or your loved one are under, ensuring you know all the important facts.

Original Medicare

For those who are under Original Medicare coverage, because assisted living is not considered medically necessary, it will not be covered under Parts A and B of this coverage. However, Original Medicare Part A does cover eligible short-term stays in a skilled nursing facility for each benefit period – but coinsurance will apply after 20 days and out-of-pocket costs will begin after 100 days. 

Original Medicare does cover some aspects of home health services and hospice care, as well. It will also pay for all approved services under Parts A and B. 

Medicare Advantage

For those with Medicare Part C (Medicare Advantage), whether assisted living is covered will depend on the specifics of the Part C plan (private insurance) being used. Medicare Advantage includes everything in Parts A and B, and does not cover assisted living costs under this section – but if your loved one needs skilled nursing care as deemed necessary by a doctor, Medicare Part C may cover this if they are in an assisted living community that offers it. 

However, always check with your specific plan to see what is covered and what is not.

Medicare Supplement (Medigap)

Sold as a private insurance option, Medigap helps cover certain costs for those under Original Medicare Parts A and B. However, as with Part C, Medigap policies do not cover assisted living – but they may pay for some out-of-pocket expenses like copayments or deductibles that are associated with skilled nursing care in an assisted living setting.

Dementia Patients

In cases where the senior in question is managing dementia or related conditions, Medicare does cover certain costs here. These include hospital care, home health care, cognitive assessments, hospice care, medications and skilled nursing home care. There may also be care planning services that are covered. However, assisted living services are not specifically covered here. 

Other Payment Methods

Luckily, there are other payment methods available for seniors looking at assisted living communities. These include private insurance, long-term care policies and certain state programs such as Medicaid, which may cover some costs depending on the community and individual situation. Additionally, some communities offer special financial assistance or discounts to help make assisted living more affordable.

In addition to these options, there are also resources available to help seniors and their families navigate the complex world of assisted living costs and coverage. Organizations like AARP, the National Council on Aging, and local agencies on aging can provide valuable information and resources to assist in making informed decisions about senior care options. 

At Cozy Retire, we understand the importance of providing affordable care for seniors and their families. That’s why in addition to offering competitive room rates, we also work with families to explore all available options for financing assisted living services. Contact us today to learn more about this or any of our assisted living, senior living or other retirement community services.