Assisted living is a long-term care option that can provide housing as well as daily living support. Assisted living residences are typically not skilled nursing facilities, but instead, help with daily care needs such as managing prescriptions, meal preparation, and housework. Generally, Medicare doesn’t cover assisted living. Original Medicare Part A covers hospital care. Part B covers medical care from a doctor’s office. Medicare Part D is coverage for prescription costs. Medicare Part C – Medicare Advantage – also doesn’t cover assisted living costs.
What is Covered by Medicare?
Services from assisted living centers typically involve help with meal preparation, bathing, personal hygiene, and medication management. Medicare considers such services custodial, so they generally are not covered.
Medicare Part A, however, may offer coverage if you need short-term care in a skilled nursing facility, such as during recovery from an operation. Medicare Part A may cover other specialized nurse duties, such as medical treatment for wounds.
Medicare and Skilled nursing
As discussed, Medicare may include coverage for a skilled nursing facility if you are discharged to such a facility following a hospital stay. A skilled nursing facility is different than an assisted living facility because it provides a higher level of care. Skilled nursing care may include physical and respiratory rehabilitation, occupational therapy and speech therapy.
These types of skilled nursing services are covered under Medicare Part A and are subject to limitations regarding the number of days per year and medical necessity.
Home Health Care and Medicare
Home health care services are sometimes recommended by a physician as opposed to a stay in a skilled nursing facility or assisted living center. There may be Medicare coverage for home health services if they are considered medically necessary by your doctor. Again, there are limitations on what Medicare will cover for home health services.
Also, to be considered for Medicare coverage, home health services must be regarded as skilled nursing services. Again, a custodial type of care is not covered.
Options for Assisted Living Care
If you need custodial care such as the type not covered by Medicare, consider hiring a home health aide or applying for assistance through your state’s Medicaid office. Also, if you have a long-term care policy, check the policy benefits for assisted living coverage.
Medicare Advantage and Assisted Living
Medicare Advantage plans typically don’t include coverage for assisted living facilities, but they do offer other benefits. Medicare Advantage can provide dental care, vision and hearing services as well as prescription drug coverage.
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