Is assisted living covered by Medicare or long-term care insurance?

Unfortunately, Medicare usually does not cover the costs of assisted living or long-term care facilities. Traditionally, Medicare is used to pay for skilled nursing facilities or home health care. The exception to this rule is that Medicare can be used to cover medical expenses incurred at an assisted living facility.

For example, if a doctor determines that you need specialized care after hospitalization, Medicare may pay for a portion of a stay at an assisted living facility for a short period of time. For those on a limited income, Medicaid may step in to help seniors and individuals with disabilities afford assisted living. In many cases, however, individuals must first spend down their personal assets to qualify for Medicaid coverage. Many advisors are somewhat fuzzy on the Medicare and Medicaid rules related to assisted living, so you’ll want to check with two or more experts to make sure you maximize your benefits and minimize your out-of-pocket expenses.

Most residents pay out-of-pocket for assisted living care or rely on long-term care (LTC) insurance to cover a portion of their assisted living payments. Private funds and personal assets, often from the sale of a home or retirement savings, are commonly used to pay for assisted living facilities.

LTC insurance policies vary widely by state and level of coverage. Still, most will reimburse you for expenses at an accredited assisted living facility as long as your insurance has approved the facility. It’s best to review your policy and work with your insurance provider beforehand to discuss your plan and determine your best course of action. Providers are often able to cover facilities across the spectrum of care, but you must make sure to dot your i’s and cross your t’s.

Assisted living exists in the space where individuals are still capable of many independent daily activities but require some support from staff rather than the constant medical attention needed at nursing homes or other advanced senior care alternatives. To qualify for long-term care insurance benefits, an individual generally needs to require help in at least two major activities of daily living.

For more information about your options regarding how to pay for assisted living, please contact us. Our skilled representatives will evaluate your options and discuss which resources may be available to you to help you afford assisted living services.