Does Medicare Pay for Assisted Living

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I can promise you that here in Alabama, Medicare pays for NOTHING when it comes to Assisted Living. In fact, with my Mom, who is in the final stages of Alzheimer’s, it has been an act of God for Medicaid to help us. While Mom was in the Assisted Living since 2005, my family has gone through every cent of savings, 401k, and paychecks trying to meet the bill every month. The bottom line is the law needs to change. The people with Alzheimer’s, as well as their families need some sort of re-course. As for Medicaid, every time we turn in the paper work (4 times now), if they even acknowledge they have received the paperwork, they have sent us back a letter saying they need something else. It has gotten so bad, that we are now hand delivering all paperwork and keeping copies of everything. Why they don’t have a list of everything you are going to need posted, is a major concern. I think my Mom will pass away before Medicaid gets around to approving her case. What’s more difficult is the Nursing Home side of facilty cost us $5000 / month where as the Assisted Living was $3200 / month. Since we haven’t won the lottery, this increase hurts tremendously. Mom has to have the 24 hour care, there is no choice but to pay it.

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When Will Medicaid Pay for a Nursing Home or Assisted Living?

If you are over 55 and receive long-term care through Medicaid, or if you are permanently institutionalized before you turn 55, your state’s Medicaid program will have a claim against your estate after your death for the amount that the state spent on your care while you were receiving Medicaid. This is called Medicaid estate recovery. However, the state will not try to recover from your estate until after you spouse dies and only if you have not left any minor or disabled children. Some states, including California, can also recover the cost of Medicaid services other than long-term care services—as long as they were incurred after you turned 55.

Medicaid & Assisted Living: State by State Benefits & Eligibility

Forty-three states now provide some level of financial assistance to individuals in assisted living. However, the term “assisted living” is not used consistently across these states, nor are their definitions or benefits the same. Other terms which are used include: residential care, adult foster care, personal care homes and supported living to name a few. Some states pay only for personal care services received in assisted living, others include nursing services. Coverage for medication administration, chore and homemaker services even recreational activities varies by state. No state is permitted to pay for room and board costs in assisted living, but states have other means of controlling these costs such as by capping the amounts the residences can charge, offering Medicaid eligible individuals supplemental Social Security assistance to cover assisted living room and board (from general state funds) and paying for meal preparation and serving but not actual food costs.

Will Medicare Cover Assisted Living Costs

Traditionally, Medicare does not cover the costs of assisted living facilities or long-term care facilities. However, Medicare will cover qualified healthcare costs while your loved one is living at a certain facility. Medicare is more often used to pay for a skilled nursing facility or home health care. There are always exceptional circumstances that will allow Medicare to cover different types of care, but in most cases Medicare won’t cover the costs of “custodial care.”

How can I pay for assisted living?

Have you ever heard:  “You need to know what you need to know before you can ask questions”?  Unfortunately, this is the case more times than not.  You are often at the mercy of the person on the other end of the phone or other side of the desk.  Depending on how they feel that day, how eager they are to get home, or how devoted they are to helping people often makes a difference in the information they share with you.  There have been times when I have felt that people “blow me off” instead of helping me with my needs.  Keep this in mind when you get short answers.  Don’t let them off the hook so easy.  Ask questions to see if there is any way you could qualify.  This is important to you.  Make sure you get all your questions answered.

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