It’s no secret that assisted living costs can stretch any family budget. The median cost for assisted living in 2019 was $4,051 per month, according to Genworth’s Cost of Care Survey. However, Medicare and Medicaid may help with certain health care costs.
Medicare is national, government-funded health insurance that all Americans are eligible for when they turn 65. In some cases, disabled people under 65 can also enroll in Medicare with no premiums.
Medicare has four components:
Medicare covers only short-term, non-custodial care, so you can’t use Medicare to pay for long-term care like assisted living or a residential care home. However, Medicare may cover some of the costs of health care received while in an assisted living facility.
Here’s the short-term care that Medicare covers:
Not all three-night hospital stays automatically qualify for inpatient rehabilitation, and you’re not guaranteed a full 100 days even if you do qualify. Talk to a doctor, social worker, discharge planner, or case manager at the hospital to help determine if rehabilitation is the next best step for your loved one.
If you have private health insurance, such as Blue Cross or Aetna, you will need to contact the insurer directly to determine the amount of skilled nursing coverage included in the policy. If you’re having difficulties determining coverage, ask the social worker, discharge planner, or case manager at the hospital to assist you.
The leading government-assistance program for long-term care, Medicaid is essentially a safety net for Americans who can’t afford the care they need without help. Provided cooperatively by the federal government and states, the majority of Medicaid funding comes from the U.S. government.
Medicaid eligibility varies by state, but the federal government requires each state to cover certain populations. People with disabilities are eligible in every state. Seniors who don’t have a disability but are looking to finance long-term care with Medicaid may need to show both that care is needed and that their income won’t cover the cost of care.
Here are the requirements for Medicaid eligibility:
Keep in mind that a married couple doesn’t need to have exhausted all financial resources before qualifying for Medicaid.
Each state has its own guidelines, so it’s important to contact a state medical assistance office for more details. Or, you can contact an elder law attorney who can walk you through the nuances of a Medicaid application.
Some states also have “buy-in” programs that allow people with disabilities who have incomes above regular Medicaid limits to enroll in the Medicaid program.
Like Medicare, Medicaid acts as health insurance but it covers nearly every type of health care cost, including some long-term care costs. While each state has its own rules and regulations, Medicaid pays some costs for assisted living communities and in-home care in most states.
Here’s what Medicaid may cover:
Medicaid also may help cover costs if you can’t pay the Medicare co-pay for days 21-100 during a hospitalization, or if you can’t pay for long-term care in the skilled nursing facility after rehabilitation is complete.
If you’re looking for Medicaid-approved assisted living communities, first review information online about Medicaid Waiver programs available in your state.
You can also contact your local Medicaid office, Department of Aging, Department of Elder Affairs, or local social service agency. Be sure to request a list of all Medicaid programs in your state that your loved one may be eligible for.
Here are some other questions to keep in mind when speaking with an agent:
If your loved one is currently in a skilled nursing facility under Medicaid, ask about Medicaid’s program called Money Follows the Person. It provides states with federal funding to help seniors move out of facilities like nursing homes and back into their own home or a loved one’s home.
Samantha L. Shepherd is a certified elder law attorney and former president of the Missouri chapter of the National Academy of Elder Law Attorneys (NAELA). She is the managing attorney of Shepherd Elder Law Group in Overland Park, Kansas, and Hutchinson, Kansas.