Medicare Covers It All--Even Assisted Living?

One of the most common assumptions we as Americans make is that Medicare is going to save the day as we age and cover all of our care needs and costs as we age. Although Medicare is the gold standard of insurance for those over the age of 65, there is much that people still don’t fully understand about its’ coverage until they are at a crossroads in life and needing to access their benefits. Let’s first take a deeper look at what is covered by Medicare and then let’s breakdown long-term care costs!  


The ABC’s of Medicare


Part A: This part of Medicare is your hospital insurance. Part A is billed when acute care is needed at hospitals, skilled nursing facilities, or rehabilitation. It also covers skilled home health care and hospice services. 


Part B: This part of Medicare is termed “medical coverage.” This is what your monthly premium costs pay for and this is where your coverage can be limited by what you pay. Deductibles and copays also apply. Part B covers your annual preventative care visits, annual exams, labs, x-rays, blood work, medical equipment, orthotics, prosthetics, mental health, some therapies, as well as, some ambulance services.


Part C: This is what is called a “replacement” or an “advantage” plan. Part C plans are managed by major insurance companies and they supply members with access to Part A and Part B services, but with limitations--typically determined off of monthly premiums. These plans usually have lower monthly deductibles and they include attractive “extras” such as dental and vision plans, gym memberships, and hearing care. Be aware that these plans are ideal, and more affordable for the healthier populations--those that are not facing chronic diseases or life-limiting illnesses. 


Part D: This part of Medicare covers only prescription drugs. Be aware that depending upon which Part D is selected, certain name brands or certain formularies of drugs may have coverage limits and copays. 


*Medigap: This is an elective supplemental insurance plan that can be elected to fill in the “gaps” or cover the costs of what medicare doesn’t cover for services under Part A or Part B. 


We see where Medicare has its limits, now let’s talk about long-term care. 


Long term care can refer to long-term skilled nursing, memory care, or assisted living. These are all the settings in which serve the needs of individuals, as residents, that have a certain level of daily health care needs. Residents in these settings can have a range of needs that span a spectrum. Individuals can require daily skilled nursing care or they may only need minimal to moderate assistance with activities of daily life such as cooking, cleaning, dressing, or bathing. Their needs can determine which long term setting is optimal for their health and wellbeing--but this is where it gets tricky in how care is paid for and where insurance comes into play.


The only insurance that covers care in a long-term care setting is that of Medicaid. Medicaid recipients have limitations on finances and assets, and there are physical, cognitive and medical qualifiers that also have to be met for an individual to be eligible. Furthermore, many memory care and assisted living communities do not accept this form of insurance as payment and are strictly private pay. The vast majority of communities are all out of pocket and Medicare pays nothing for long-term care. 


So, having said that, are there resources to help offset costs? Yes! Many veterans and surviving spouses of veterans may be eligible for what is called “Veteran’s Aid and Attendance.” Through an application process with the Department of Veteran Affairs, some individuals may qualify for financial assistance to help offset the costs of assisted living or memory care. 


Secondly, there are many private long term care policies in existence, that in some cases, provide coverage for care in long-term settings. What is to note, however, no long-term care insurance plan is the same, benefits are very dependent on insurer or deductible, but in some instances, there are benefits that can be navigated through as we age and require personal care or have age-related cognitive needs. 


For more help in navigating long-term care, paying for care, or to learn about Medicare follow us on Facebook, sign up for a MMAP session this fall with us, or come visit!