As with most things nowadays, the cost of long-term care and assisted living facilities is on the rise. With most facilities costing several thousand dollars a month—upwards of $50,000 a year, on average—it’s natural for people to wonder if insurance or Medicare will help to cover any part of these expenses. Here’s what you need to know about plans that can help with assisted living facility expenses.
Health insurance plans typically do not cover the expenses associated with long-term care. In certain circumstances, you may be able to receive reimbursement for nursing care at a skilled nursing facility due to an injury; for example, if you need a hip replacement and must temporarily live in a nursing facility, this would be considered medical care, and is more likely to be covered.
However, because long-term care is generally focused on assisting with daily tasks, rather than providing skilled medical care, it won’t be covered by most health insurance plans.
Many people covered by Medicare are hopeful that assisted living will be part of the covered expenses, but again, that is rarely the case. Original Medicare, or Medicare Part A and Part B as it is sometimes called, pays for short-term care from a doctor or at a hospital. It may also pay for hospice care. However, long-term care is not covered under this type of insurance either.
The one area you may be able to receive reimbursement for is any kind of treatments received while in assisted living. For example, if you receive treatment from one of our visiting physicians, Medicare should reimburse you for that cost. What Medicare will not cover is your basic room-and-board expenses, custodial or personal care, and any costs for activities and events.
Additionally, it’s worth noting that Medicare Advantage and Medicare Supplement plans don’t cover long-term care costs either.
If you qualify for Medicaid, this type of coverage is one that actually can help you with the costs of assisted living. While it won’t typically cover the full cost, Medicaid can help low-income individuals afford assisted living by covering at least a portion of the total expenses. You will need to reach out to your local Medicaid office to determine if you qualify.
It’s also important to be aware that not all assisted living communities accept Medicaid. So, after determining that you qualify for Medicaid, you will need to do some thorough research to find a facility that accepts this form of payment.
Long-Term Care Insurance
Long-term care insurance is the best way to ensure that you have some insurance coverage when it comes to assisted living expenses. Unfortunately, it’s not an insurance plan that you can jump into immediately before needing long-term care. You must enroll in this type of insurance years in advance, and you’ll need to meet medical requirement for your particular policy to cover the costs. Essentially, you must have a proven medical need for daily assistance, or else long-term care insurance won’t cover the cost of a facility.
While long-term care insurance is an excellent way to offset the rising costs of assisted living, it’s something that must be planned for well in advance. So, if you’re considering the need for long-term care years down the road, it’s a smart investment. However, if you’re currently searching for a care facility or are already in one, long-term care insurance won’t be an option for you.
For veterans, there are options available to help with the cost of long-term care. If you’re a veteran, contact your VA office about the Aid & Attendance benefit, which can help pay for care in an assisted living community. This benefit essentially increasing your pension amount so that you have the additional funds needed to pay for the care you require.
The Bottom Line
When it comes to insurance coverage for assisted living in Daytona Beach, the bottom line is that there are very few options available to current residents or those hoping to become residents very soon. Essentially, you must be a veteran or qualify for Medicaid to receive insurance coverage for these costs. However, our hope is that, as life expectancies rise, more people will begin to plan ahead for these care needs and will purchase long-term care insurance, so that they can ensure they receive the care they need in their later years.
If you have questions about working with Medicaid or other types of coverage to pay for your residency here at The Sarah House, contact our staff today.