When you are looking into assisted living for a loved one, an extremely influential factor to consider is whether Medicare will pay for it. Let’s be honest: not everyone can afford to pay thousands of dollars out of pocket each month, and with the help of Hermitage Roanoke, a Roanoke, VA assisted living facility, we will go over all of the alternatives. So, the most important and pressing question is, will Medicare cover your loved one’s assisted living costs?

Typically, Medicare doesn’t pay for assisted living; however, they will cover some qualified healthcare costs at certain facilities such as doctor’s visits, labs, physical or occupational therapy, and all the normal things that were covered before assisted living.

The Difference Between Medicare and Medicaid

The main difference in Medicaid and Medicare is that Medicare is for people aged 65 and over, where Medicaid is for very low-income people of any age. You can, in some circumstances be eligible for both, which is called a “dual-eligible”.

Dual-eligibles have enhanced benefits such as not being limited to Medicaid doctors and not being limited to Medicare’s regulations.

If your loved one has a limited income, in some states, Medicaid will pay for some of the costs associated with assisted living. Check with your state to find out for sure if it can be covered.

What Facilities Does Medicare Cover?

Medicare covers most skilled nursing facilities as well as home health. They also typically pay for qualified healthcare costs even in an assisted living facility.

According to Brookdale.com, they do not pay for “custodial care” (non-medical care that helps individuals with their daily basic care, like eating and bathing).

How to Pay for an Assisted Living Facility

Some assisted living facilities offer their own personal funding for residents. Others are based on income, which means they won’t charge you more monthly than what you can comfortably pay.

Assisted living could cost anywhere between $2,000 and $5,000 per month and, according to NextAvenue, includes medical, hygiene, and mobility costs, depending on the facility.

It can be hard or impossible to cover these costs for a loved one, and figuring it all out can be a huge headache, but there are other options out there to help you come to a conclusion:

  • Geriatric planner: A geriatric planner is someone who has been trained in various fields of human services. They are beneficial when trying to find the right place for a loved one because they have a wealth of knowledge on the topic. They should know what is and isn’t covered by Medicare, any underlying coverage you may be eligible for, and can tell you the facts about your options.
  • Financial concierge service: A personal financial assistant who can help you through the process of qualifying for benefits.

Here are some options for paying for assisted living:

  1. Savings: If you or your loved one has savings they haven’t touched in a long time, it may be in your best interest to draw these funds out and use them to pay for their assisted living. It’s likely not going to last long at the rates they are asking for an assisted living facility, but they may get you started while you search for another way to pay.
  2. Selling your property: If your loved one owns any real estate, it could be very beneficial for them to sell that property and use the proceedings to pay for assisted living. This is not always a possibility because personal property is typically passed down to relatives.
  3. Veteran benefits: If, by chance, your loved one is a veteran, the VA has assistance programs that can help pay for their assisted living. This is a great option that will leave you with less out of pocket expenses.
  4. Renting the home: This is a very beneficial option. If your loved one owns their home and is moving out of it to go into an assisted living facility, this could be a great opportunity to rent out the home and use the money they receive monthly to pay for their assisted living. This allows them to keep their home and still be able to pay.
  5. Medicaid: As mentioned above, you can be eligible for Medicaid and Medicare both. If this applies to your loved one, check into the state regulations for Medicaid because in some states Medicaid will pay for an assisted living facility.

How to Find Out About Coverage

The best way to know if your loved one is covered is to talk to a Medicare provider or a geriatric counselor. They will have knowledge of Medicare practices. They will also have suggestions on alternatives that may be covered.

If your heart is set on assisted living for a loved one, then investigate some of the payment options mentioned above. If you aren’t prepared to pay out of pocket expenses, look at your other options that are covered by Medicare such as a nursing home or home health care.

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