What is the Medicare Assisted Living Plan and How Does it Work?

Does Medicare Pay For Assisted Living?

Insurance, including life insurance and health insurance, is a tough subject. Insurance that covers and assisted living, senior living, memory care and dementia care for those with memory loss, memory impairment, and other Alzheimer symptoms is even tougher. The unfortunate reality is, Original Medicare (Medicare Part A and Medicare Part B) does not cover most forms of assisted living.

This can come as a shock, especially considering the high price of nursing homes. However, this doesn’t mean Original Medicare (Medicare Part A and Medicare Part B) doesn’t cover assisted living or senior living at all, nor does it mean that you don’t have other options. Some forms of Medicare Advantage plan providers, like the UnitedHealthcare insurance company, may offer assisted living coverage, memory care, access to a retirement community, and coverage for seniors or an elderly loved one who lead independent lives. Sometimes, other programs like Medicaid can also assist with those who are still able to lead independent lives

Wait, why doesn’t Medicare cover assisted living?

We can sort caregiving services into two categories: medical care and personal care.

Medical care refers to services received by a licensed medical professional with the intent of diagnosing or treating a health condition. This includes taking blood pressure, changing bandages, and performing physical therapy. If you’d see a doctor or nurse to do it, it’s probably a medical service. Many seniors or an elderly loved one who still enjoy independent lives typically still require medical care in some scenarios.

Personal care, in this context, refers to services designed to help you with daily living. This can include things like help bathing, getting dressed, or preparing meals. If you would ordinarily be able to do it yourself but are prevented from doing so due to a health condition (if you or your elderly loved one are not practicing independent lives), it would probably fall under personal care. Memory care services, for people with dementia or Alzheimer’s, involve a lot of personal care services.

Nursing home care, assisted living, and at-home caregiving all contain elements of both types of care. However, as the name suggests, Medicare typically only covers medical services. This means that the care you receive must have the primary function of treating a health condition for it to be covered. It doesn’t prevent you from getting incidental personal care services as part of a hospital stay (they’re still obligated to feed you and help you bathe, for example). However, they won’t provide long-term or day-to-day care. 

How can I get help paying for assisted living?

You may have seen ads for UnitedHealthcare’s Assisted Living Plan. This is a type of special needs plan meant for residents of contracted nursing homes and institutions. These “I-SNPs” can be a big help in paying for assisted living, provided one is available at your nursing home, assisted living facility, independent living facility, independent living community, or skilled nursing facility. Unfortunately, these plans are not very widespread. As such, you may need to look into alternative long-term care options. 

If an assisted living facility or assisted living community won’t work for you, you may need to look into home health care, though this is also only partially covered by Medicare. Medicare typically covers short-term nursing services, but not home health aides or custodial care. This means that custodial care, unfortunately, still isn’t commonly covered. Some Medicare Advantage plans may cover in-home assistance and help with the activities of daily living, but full-time caretakers are not usually covered.

Depending on where you live, you may be eligible for the Program of All-Inclusive Care for the Elderly (PACE). PACE is meant for people who need a nursing home level of care, but can also live safely in the community with assistance. As such, it’s not suitable for people who require memory care or similar services. PACE services typically include adult day care services, allowing nursing home-level care without full-time residence. Transportation, meals, and home care services are also covered.

If you qualify for Medicaid, you may be eligible for help paying for nursing home services. The facilities that accept Medicaid vary from state to state. In Florida, for instance, all nursing homes are required to accept Medicaid. The laws may differ in your state, so be sure to check your local regulations.

One exception to the lack of personal care is hospice. Palliative care services always count as medical care, and are always covered by Medicare, provided you are estimated to have six months or less to live. While in hospice, you cannot receive services aimed at curing your disease, only palliative care. You can, however, choose to leave hospice at any time. 

Are there alternatives to assisted living?

If you cannot afford a nursing home, but don’t qualify for Medicaid, there are other adult options to get the care you need.  

One option is to look into a senior center or adult daycare service. These places provide nursing home levels of care during the day, but allow you to return home in the evening. They’re a good choice for people with family members who can care for them in the evenings but need extra monitoring during the day. Senior centers also have a much more relaxed, clubhouse atmosphere than nursing homes, and transportation is typically provided. 

If that isn’t an option, or you’re uncertain of your options, contacting a social worker can help you understand your options and connect you with resources in your community.

If you need help understanding your Medicare Advantage plans or other Medicare options, we can help. Call us at (800) 950-0608 to talk to an agent, or enter your zip code to begin your search today!