December 9, 2016
Does it help cover the costs?
A version of this article originally appeared on Angie's List.
Medicare can be a complex thing, particularly when trying to sort out what it will and will not cover. Will it pay for that? Will it partially cover that? What is it not applicable for?
While the Center for Medicare and Medicaid does a great job of providing resources to explain coverage as well as communicating annual changes, there’s one question people seem to ask often: “Does my Medicare pay for assisted living or an independent senior apartment complex?”
In short, the answer is, unfortunately, no.
Medicare coverage is determined by a combination of federal and state laws, national coverage decisions made by Medicare, and local coverage decisions made by companies in each state. While Medicare coverage currently applies to care provided in a long-term care hospital, skilled nursing care in a skilled nursing facility, eligible home health care services, hospice, or respite care, it does not cover the cost of an independent senior apartment or assisted living. Since services in these settings are not considered to be medical in nature, but rather, “long-term care,” “custodial,” or “supportive of activities of daily living,” they don’t qualify for Medicare coverage.
With a potential cost of several thousand dollars per month, the cost of assisted living can be daunting, so it’s a good idea to also become informed of other options that may help cover the expenses. Working with a geriatric planner at an assisted living community can be a great help, and it’s always wise to ask about financial concierge services. They may assist you in discovering that you’re eligible for Veteran’s benefits, for example, or that you qualify for a special payment option.
Additionally, long term care and life insurance policies can be a life-changing investment for many people. Where Medicare will not pay for assisted living, most long term care insurance policies will, and a life insurance plan may often be cashed out for living benefits. As always, check the fine print of your individual plan to be sure and work closely with a professional to understand your policy, benefits, and options.
Doing your own research to gain information on your Medicare and other insurance plans is time well spent. It’s important to know what will be paid for and what won’t, so that there are no surprises in a time of need.