Setting the Record Straight on Who Pays What for Senior Living

There are too many misperceptions to count when it comes to senior living, but some of the most prevalent have to do with cost. Specifically, what you’ll pay for care and how the cost of senior living compares to home. Learn the facts here.

Misperception: Medicare will pay for all of your senior living costs.

Fact: Actually, Medicare only pays towards senior living costs if you require skilled services or rehabilitative care: 

Following an inpatient hospital stay of at least 3 days

• In a Medicare-certified skilled care facility for a maximum of 100 days to receive nursing services, physical therapy or other types of therapy. However, Medicare only pays 100% for the first 20 days.

Prescribed by a doctor as medically necessary to treat an illness or injury

• With part-time or intermittent skilled nursing care

To prevent further decline to medical conditions

• With ongoing long-term care services in senior living for people who have medical conditions that may not improve such as stroke, Parkinson’s disease, ALS, multiple sclerosis or Alzheimer’s disease.

However, Medicare does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term senior care services. 

Misperception: Medicaid will pay for the senior living costs that Medicare doesn’t.

Fact: Medicaid does pay for skilled nursing services in senior living. But to qualify, your income must be below the level set by your state and you must meet state eligibility requirements based on the amount of assistance you need with ADL. Also, covered services may vary from state to state.

Misperception: Health insurance will pay more towards senior living costs than Medicare. 

Fact: Unfortunately, that’s not really the case. Health Insurance through your employer or even through a private health insurance plan typically covers the same kinds of senior living costs as Medicare.

Misperception: Senior living always costs more than staying at home.

Fact: Senior living is more affordable that you may think. In a previous blog, we discussed what you can expect to pay for senior living [link], however many families incorrectly compare those monthly costs to their monthly rent or mortgage alone. This is not a true comparison! The comparison should be between your monthly senior living costs and the total cost of living at home — mortgage or rent as well as the cost of food, utilities, home maintenance, property taxes, insurance and entertainment. Why? These things are all typically included in the monthly cost of a senior living community.  Also, don’t forget the costs of home health care and/or any home modifications you may need. After adding it all up; you may find senior living to be less expensive than home! 

For more information download our Family Guide to Funding Senior Care & Housing or contact us today to schedule a tour.

Source: Administration for Community Living; https://acl.gov/ltc/medicare-medicaid-and-more