Will Medicare and Medicaid cover the cost of my move to an assisted living community?

This question is probably one of the most commonly asked and misunderstood when folks begin planning for their senior years. The answer is a complicated, “maybe.”

The more straightforward answer is Medicare and Medicaid are usually not the primary or best source for paying your monthly housing expenses. However, these government programs can help with many of the special services that are often associated with living in an assisted community.

Let’s take a very detail look at what Medicare and Medicaid will specifically cover.

If you have questions about the care our team at The Kensington Falls Church can provide, please don’t wait to get in touch with us.

Medicare

Medicare is a federal health insurance program for people over the age of 65. This program is designed to assist seniors in paying for hospitalization, medical expenses, and the cost of prescription drugs.

Traditionally, Medicare is designed to cover ongoing healthcare costs and short-term rehabilitation. Typically, Medicare is used to pay for a skilled nursing facility or home health care. Under Medicare guidelines, most assisted living communities would fall into the classification of “custodial care,” which is not Medicare qualified.

Medicare is broken down into two coverage choices: Original Medicare and Medicare Advantage Plan (Part C). This coverage is then broken down into Part A and B.

  • Part A (hospital insurance) covers inpatient hospital care, skilled nursing facilities, hospice, lab tests, surgery, and home health care.
  • Part B (medical insurance) covers doctor and health care provider services and outpatient care. Part B also covers medical equipment, devices, home health care, and some preventative health care services.
  • Part D is for prescription drug coverage. This area of Medicare is probably the most complicated part of the program, with various options.

As you can see, there are probably opportunities to use Medicare to offset the cost of many special services and individual care associated with assisted living communities, but not necessarily the cost of housing specifically.

You can learn more about Medicare, what it covers, and how to apply for coverage at Medicare.gov.

Medicaid

Medicaid provides health care to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered and funded jointly by the states and the federal government.

Typically, Medicaid is designed only to cover nursing home stays. However, many states have realized that offering a continuum of care, like assisted living, is far more economical than the cost of most nursing homes.

Consequently, many states have begun to create waiver programs that allow for Medicaid to be used to pay for some assisted living community costs. Each state’s programs vary widely, so it’s important to check your specific state’s waiver programs and qualifying requirements.

You can research your specific state eligibility and enrollment requirements on Medicare.gov under State Overviews.

Learn more about Medicaid, what it covers, and how to apply for coverage at Medicaid.gov.

If you have questions about the care our team at The Kensington Falls Church can provide, please don’t wait to get in touch with us.

Other Assisted Living  Community Funding Options

Although Medicare and Medicaid can help with the cost of health care as we age, it’s probably not going to be of much assistance in covering our senior housing costs. As you start planning for an assisted living community, it’s important to consider other financial strategies.

The good news is that most people forget that they are already paying a significant portion of their current or retirement income on housing expenses. Moving to an assisted living community, and the monthly housing expense is often a pretty equivalent offset – not an additive cost.

Because of this fact, most people pay the monthly assisted living community housing expense from the proceeds of selling their home, retirement savings (i.e., 401k, 403b, IRAs, etc.), required retirement distributions, or other investments and savings. Then, they use Medicare, Medicare supplements, and other long-term care insurance to pay for additional health care expenses associated with aging.

Learn all the ways to pay and plan for a move to an assisted living community by reading our How to Manage Paying for Assisted Living.

If you have questions about the care our team at The Kensington Falls Church can provide, please don’t wait to get in touch with us.

What Questions Can We Answer?

Our staff at The Kensington Falls Church is always available to answer any questions about our communities, financing assisted living, and how to become a new resident.

Please, never hesitate or delay your question – contact us anytime.

Schedule a Visit

If your loved one is considering transitioning to assisted living or a memory care community, we cordially invite you to come and see The Kensington Falls Church Difference for yourself, and how we fulfill our promise to love and care for your family as we do our own.

Further Reading

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