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Original Medicare does not cover nursing homes or stays in assisted living facilities, but does cover some in-home and hospice services.
PACE, a program offered in some cities, can help pay for nursing home stays.
Medicare Advantage can help cover medical treatment and prescriptions received at an assisted living facility, but will not typically cover stays in a nursing home.
As we get older, sometimes we need a little extra help with everyday tasks, like cooking, cleaning, or even simply dressing ourselves. Long-term care services can help you with activities of daily living, either through the help of in-home aides, nursing home services or assisted living facilities. Unfortunately, these services can get very pricey, leading many people to wonder: Does Medicare cover long-term care? Does Medicare pay for assisted living? Nursing homes? As with all things related to Medicare, the answer depends on what service you’re seeking out, and what kind of Medicare you’re aiming to use.
If you have Original Medicare (Parts A and B), the answer to the question of long-term care coverage is, unfortunately, no. That’s because long-term care as Medicare defines it is, by definition, non-medical. It provides support services for everyday living, but nothing medically necessary.
That doesn’t mean you’re entirely out of luck. Original Medicare will cover some in-home care as part of medically necessary treatment and can cover a stay in a skilled nursing facility. Hospice care is also covered under Original Medicare.
So if Original Medicare won’t cover the cost of long-term care insurance, what can you do? Fortunately, you’ve still got options.
Depending on where you live, you may be eligible for PACE. PACE is an expanded program run jointly by Medicaid and Medicare, designed for seniors who need a nursing home level of care. It covers nursing home care, adult day care, and respite care for those relying on family for their daily needs, among other services. PACE is offered at no cost to people who qualify for Medicaid. If you do not qualify, you’ll still need to pay a monthly premium but won’t be expected to pay deductibles, copayments, or co-insurance for PACE services.
The downside to PACE is that it is only offered in certain locations. Only 31 states currently offer PACE, and the number of PACE organizations in a state can vary wildly. For instance, Pennsylvania has 20 PACE Organizations spread across the state while Florida only has 5. Coverage areas also tend to be limited to single cities: often large population centers. Even then, living in a metropolitan area is no guarantee of PACE coverage. Texas has only three PACE offices, based in Amarillo, El Paso, and Lubbock. Houston, San Antonio, and Dallas have no PACE coverage to speak of.
Alternative options for long-term care, like community-based services and subsidized housing, may be available in areas that do not offer PACE. You can use the official Eldercare Locator to find services near you.
A Medicare Advantage plan can help you pay for long-term care, even where Original Medicare cannot. Medicare Advantage, also known as Medicare Part C, is an enhanced Medicare program offered by private insurers. In addition to the basic coverage offered by Original Medicare, Medicare Advantage plans may offer enhanced coverage while in a nursing home or long-term care facility, covering medical treatment and prescriptions. However, full coverage for nursing homes and assisted living facilities is rare. However, your plan may cover adult day care services, part-time in-home help, or respite care for those living with a caretaker. Check with your provider to see what services are available under your plan.
You might have more options for long-term care than you think. Contact one of our licensed insurance agents at (800) 950-0608 or enter your zip code to begin exploring plans today!
