How Medicare and Medicaid Support Different Levels of Care in Senior Living
If you’re retiring or considering your options in senior living, you’re probably thinking about healthcare and planning your future. Now is always a good time to figure out your options with Medicare and Medicaid and how they can support different levels of care. Here is a basic list of all the possible levels of care in senior living and what each insurance plan covers.
What are Medicare and Medicaid?
Medicare is a federal health insurance program for people ages 65+ and younger people with specific disabilities or medical conditions, such as permanent kidney failure. There are four types of Medicare that cover different health services:
- Part A provides hospital coverage, including inpatient hospital care, skilled nursing care, hospice care, and some home health care.
- Part B provides outpatient and medical coverage, including physician visits, durable medical equipment, and ambulance services.
- Part C provides alternative ways to receive your Medicare benefits and takes care of more routine healthcare, such as dental and vision. NOTE: These “Medicare Advantage Plans” are only administered by Medicare-approved private insurance companies.
- Part D provides prescription drug coverage.
Medicaid is a joint federal and state public insurance program that provides medical and health coverage for low-income families and individuals, including seniors and people with disabilities. Medicaid offers benefits not often covered by Medicare, but it’s administered by individual states, meaning the provided coverage and eligibility requirements vary significantly by state.
Home and Community-based Services
Home and Community-based Services (HCBS) are the care, services, and support delivered to a person’s home, such as caregiver support, home health care, and transportation.
Medicare covers the medical services you might need beyond your home health care, but Medicaid is the program that supports HCBS if that is the route you take. Make sure to get on Medicaid to optimize your choice to age in place and cover HCBS.
Independent Living is a community living option for people ages 55+ who don’t need assistance with daily activities but want additional amenities, a maintenance-free lifestyle on campus, and support whenever they need it.
Medicare does not pay for Independent Living since it only covers healthcare services. Medicaid does not pay for Independent Living because this living option does not include medical or personal care services, but it will continue to cover HCBS if you choose to still have that.
Assisted Living is a community living option for people ages 55+ who need various levels of medical and personal care, such as housekeeping, meal preparation, and hygiene, to maintain as much of their independence as possible.
Medicare will continue to cover approved medical care through Part A and Part B, but it does not cover custodial care, long-term care, or Assisted Living. Medicaid varies from state to state in terms of what it covers in Assisted Living, so it’s best to check the Medicaid state programs and Medicaid waiver programs to see how you’re covered.
Skilled Nursing, Rehabilitation, and Long-term Care
Skilled Nursing is a supportive environment that provides comprehensive medical and rehabilitative care, including physical, occupational, and speech therapy, within a senior living community. Long-term care is the support and services to maximize a person’s quality of life on a daily basis when they can’t care for themselves.
Medicare does not cover long-term care but covers part of the first 100 days of rehabilitation if the required conditions are met. Medicaid could cover long-term care, skilled nursing, and therapy if you meet your state’s eligibility requirements.
Memory Care is a community living option that provides people ages 55+ living with Alzheimer’s and dementia the care tailored to their unique needs.
Medicare covers the healthcare costs associated with Alzheimer’s and dementia, such as appointments, medications, and testing, but it won’t cover the rent, board, or personal care in Memory Care. Medicaid also does not cover room and board for Memory Care, but as long as the senior living community is licensed as a Medicaid-approved community and accepts Medicaid, waivers could potentially cover services. Memory Care residents who also receive Skilled Nursing care could be fully covered by Medicaid.
Hospice is the holistic care for an individual with a terminal illness approaching the end of life and comforting support for the family.
Medicare can cover hospice care if you have the right plan and utilize a Medicare-approved hospice provider. Medicaid provides an optional state plan service for hospice care.
Look to a brighter future with your finances when you read our free ebook, 6 Money Planning Tips for Your Senior Living.
At Life Enriching Communities (LEC), we’re committed to ensuring patrons feel well-equipped to plan their future and age how they wish. Explore more resources on senior living or contact us today to learn more about our legacy of services and programs that bring meaning and purpose to every stage of life.