As individuals age, the need for long-term care becomes a significant consideration. One popular option for those who require some assistance but wish to maintain independence is assisted living. In this blog, we explore the costs associated with assisted living, whether Medicare covers these expenses, and alternative ways to fund this form of care.
According to a report from the National Center for Health Statistics, a person reaching the age of 65 can expect to live over 18 additional years. With the likelihood that 7 in 10 individuals turning 65 will need some form of long-term care, planning for these expenses becomes crucial.
Understanding Assisted Living
Assisted living communities offer freedom and independence for seniors with the supportive environment for older adults who may need help with daily activities but do not require constant medical care provided by skilled nursing homes. Assisted living residents often have common conditions such as asthma, coronary heart disease, rheumatoid arthritis, sleep issues or vision loss, or other conditions that are medically monitored but the resident can still live a relatively independent life. Residents usually have private living spaces and access to communal areas, recreational activities, and various services.
People often ask how an assisted living community is different from nursing homes. Assisted living communities are geared toward active older adults who seek assistance with activities of daily living such as medication administration and showering. Nursing homes provide intensive, skilled medical care in a clinical, long-term setting for people with serious and chronic health conditions.
Does Medicare Cover Assisted Living?
Contrary to common belief, Medicare does not cover the costs of assisted living facilities or other long-term residential care. Under Medicare Parts A and B, Medicare will pay for approved services such as hospital stays, short-term rehabilitation stays, doctor visits, procedures, and screenings. Assisted living primarily involves custodial care, such as help with daily activities, which Medicare does not cover.
Why Won’t Medicare Pay for Assisted Living?
Many families are surprised to learn that Medicare does not pay for assisted living—but this comes down to how Medicare is designed.
Medicare is a federal health insurance program focused on medical care, not long-term daily support. Assisted living primarily helps with activities of daily living, such as:
- Bathing and grooming
- Dressing
- Medication reminders
- Meals and housekeeping
- Supportive supervision and safety
Because these services are considered custodial care rather than medical treatment, Medicare does not cover the cost of assisted living communities.
That said, Medicare may still help pay for certain medical services a resident receives while living in assisted living, such as:
- Doctor visits
- Hospital stays
- Physical or occupational therapy
- Skilled nursing care for a limited time
These services are billed separately through Medicare, but the monthly assisted living costs remain private-pay.
How Much Does Assisted Living Cost?
The average cost of assisted living was $5,770 per month in 2022, according to the 2022 ASHA State of Seniors Housing handbook. Costs vary based on factors such as location, type of care required, and facility amenities. While some individuals use personal savings, pension plans, or retirement accounts, there are other options to explore.
Common Ways to Pay for Assisted Living
Long-Term Care Insurance:
- Policies usually cover assisted living after a waiting period.
- Coverage may differ between older and newer policies.
Veterans Benefits:
- VA pension recipients may qualify for Aid and Attendance benefits may cover a portion of assisted living and independent living costs.
Private Funds:
- Individuals can use personal savings, pensions, or other private funds to cover costs.
Medicaid:
- Some states offer income-based Medicaid waiver programs for assisted living.
- Eligibility criteria and covered services vary by county and state.
- Primrose does not accept Medicaid except for the Wasilla, AK and Gillette, WY locations.
Planning Ahead for Assisted Living
The decision to move to an assisted living community is significant, and planning ahead is crucial. Even if independence is maintained, considering long-term care options early allows for informed decisions. For those with Alzheimer’s or cognitive impairments, early planning is particularly important.
It’s also important to understand the range of amenities that are included in assisted living costs. While there may be additional nursing fees as a resident’s needs increase, many services are still included with the monthly rent. For example, at Primrose, daily activities, meals, transportation, events, housekeeping, and laundry are already included at no additional charge. Being aware of what is included and what may not be helps individuals and families plan comprehensively.
In summary, Medicare does not cover assisted living costs. Exploring options like long-term care insurance, Veterans benefits, and private funds is essential for individuals and families navigating the complexities of long-term care. Planning ahead and understanding available resources can contribute to a smoother transition to assisted living and ensure financial well-being in their long-term care journey.
References:
Does Medicare Cover the Cost of Assisted Living? – GoodRx
Is Assisted Living Covered By Medicare? (ncoa.org)