Medicare vs. Medicaid: Which One Pays for Assisted Living?

When it comes to long-term care, many seniors may consider Medicaid and Medicare. Designed to provide financial assistance for seniors, both feature different eligibility requirements and coverage. It’s crucial to understand the ins and outs of Medicare and Medicaid—especially when it comes to assisted living. Grab some paper, put on your reading glasses, and get ready to take some notes. Here’s what you need to know.

Medicaid Assisted Living Coverage

Medicaid is a joint federal and state program that provides healthcare coverage for low-income individuals, including older adults. This program covers a wide range of healthcare services, including assisted living services. However, the Medicaid-assisted living coverage requirements vary widely from state to state. To qualify for Medicaid assisted living coverage, you must meet specific eligibility requirements, such as having a limited income and a medical need. Once you’re approved for Medicaid-assisted living coverage, you’ll receive access to services like personal care, housekeeping, and more! Your state’s Medicaid agency can provide more information about eligibility requirements and covered services.

Does Medicaid Cover Respite Care?

Respite care is any service or support that provides short-term relief to caregivers. Respite allows those who regularly care for a loved one to take time away from their usual duties. Many caregivers use respite when they need to work, go on vacation, or just want a break. So, does Medicaid cover respite care? The answer is a little complicated. With Medicaid, rules differ from state to state. Some states may provide coverage through a waiver program, while others may not provide coverage at all. In order to find out if Medicaid coverage for respite care is available in your state, visit the Medicaid HCBS program page.

Medicare Assisted Living Coverage

Unlike Medicaid, Medicare is a federal program that provides healthcare coverage for senior adults aged 65 and older. However, it has limited coverage for assisted living services. However, Medicare provides coverage for skilled nursing care, short-term rehabilitation care, and hospice care. If you’re seeking long-term care in assisted living, Medicare may NOT be your best option.

Fortunately, Medicare Advantage plans, offered by private insurance carriers approved by the Centers for Medicare & Medicaid Services (CMS), may provide some coverage for assisted living. It’s important to research carriers and plans carefully because coverage varies.

Does Medicare Cover Respite Care?

Medicare Part A only covers respite care if it’s a part of the recipient’s hospice care. To quality for respite care, the recipient must first meet the requirements for hospice care. Respite care in this context provides short-term inpatient care in a skilled nursing facility or hospital when the usual caregiver needs assistance or a break. The benefits of hospice respite care include:

• Providing a temporary break for caregivers
• Allowing caregivers to attend to personal needs or emergencies
• Providing the terminally ill patient with ongoing hospice care

Respite care through Medicare is considered short-term and limited to five consecutive days per respite care stay. It can be repeated multiple times, if needed for the patient’s care plan. If you’re not eligible for Medicare-covered respite care, Medicare suggests seeking private insurance coverage or assistance from local community resources and programs designed to support caregivers and individuals who require ongoing care. Additionally, your local Area Agency on Aging (AAA) may be able to provide resources and insight!

Questions to Consider

As you consider long-term care options, you may ponder Medicaid and Medicare benefits for assisted living services. Specifically, how do you know which one is right for you and your individual circumstances? In order to make the best possible decision, you’ll need to ask yourself some tough questions. Here are a few to consider:

• Does Medicare cover nursing home or assisted living care?
• Does Medicare pay for assisted living beyond short-term rehabilitation?
• What are the eligibility requirements for Medicaid and Medicare?
• What are the differences between Medicaid and Medicare?
• Can I receive Medicaid and Medicare coverage simultaneously?
• What services are covered under Medicaid and Medicare?

What if I’m not eligible for either?

It happens! Some people may not be eligible for Medicaid or Medicare coverage of assisted living. When this happens, you may need to pay out-of-pocket or consider other funding sources. Some facilities offer payment plans or financing options to make their services more affordable. Additionally, you may be able to use a reverse mortgage, life insurance policy, or annuity to fund your long-term care expenses.

It’s important to plan ahead for your long-term care needs. Luckily, various planning tools and strategies can help you protect your assets and ensure you have access to quality care when you need it. For example, long-term care insurance can help cover the cost of assisted living and other long-term care services, while also preserving your assets. Always consider consulting with a professional who specializes in senior living and care, such as a financial planner, elder law attorney, or geriatric care manager. Not only can they help you understand your options, but they can help you make an informed decision for your unique situation!

Are There States Where Medicaid Coverage Is Limited?

Alabama

Alabama’s Medicaid program does not directly cover the cost of assisted living facilities. However, Medicaid may provide funding for other long-term options, such as skilled nursing facilities.

Kentucky

Like Alabama, Kentucky’s Medicaid program does offer financial assistance when it comes to assisted living facilities. However, the state does have a Home and Community-Based Waiver that can be applied to skilled nursing facilities.

Pennsylvania

Through its HealthChoices Program, Pennsylvania provides a wide array of personal care services for residents of assisted living facilities.

Tennessee

While Tennessee does not extend to assisted living facilities, it boasts a program known as CHOICES that provides personal care services, respite care, and more to recipients who qualify.

Looking for more?

While long-term care can be expensive, you still have many options for financial assistance. Still looking for more information on Medicare? Then visit our Medicare & More Blog for more great articles!

If you’re looking for more great articles on assisted living, check out these next:

• Meow-Meow! A Comprehensive Guide to Pet-Friendly Assisted Living Facilities
• A Guide to Assisted Living: What it is & its Advantages
• Assisted Living on a Budget: 5 Proven Tips to Help You Afford It
• 5 Assisted Living Pros & Cons to Consider Before Moving In
• Assisted Living Vs Nursing Homes: What’s The Difference?
• Assisted Living Vs. Home Care & How to Choose

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