The transition to assisted living can be hard for a wide variety of reasons. But when finances come into the picture, the move can feel downright overwhelming.
Senior solutions are notoriously hard on the wallet. And many assisted living facilities aren’t even covered by standard insurance plans. Still, if you get a sense of what you can cover, you can still make it through this with your wallet and peace of mind intact.
We’ll walk you through what you need to know about coverage for senior living.
Elements of Senior Life Solutions in Assisted Living
If you’re new to the world of assisted living, you might be fuzzy on what counts as assisted living (compared to independent living or a nursing home).
The short answer is that assisted living exists in between those other two categories. It allows for more freedom than a nursing home, while also providing more care than independent living.
To understand why certain types of insurance will not cover assisted living, you’ll have to get a sense of what assisted living covers. These elements make assisted living somewhat different from typical medical care.
A Place to Stay
One thing that differentiates assisted living from hospital stays in the eyes of insurance providers is that it’s a place where people plan to stay for the foreseeable future. If you or a loved one move into an assisted living facility, that will become your new home.
This is different from a hospital stay (even an extended stay), where you would still presumably have your regular home.
Daily Meals
Another major element of assisted living is food. Most assisted living facilities will offer room and board, not just the room itself.
While this arrangement may be medically necessary in the big picture, many insurance plans will treat this kind of this as separate from more acute medical needs.
Overnight Care
Perhaps the most pressing reason why you might be considering assisted living—and also a very good reason why you might assume any insurance would cover this cost—is the overnight care these facilities provide.
Many people enter into assisted living facilities when it becomes clear that it is independent living is no longer safe enough. For example, someone who has developed a medical condition that requires care at unpredictable times may need around-the-clock support.
Long-Term Care Insurance
When it comes to assisted living, the problem with many types of insurance is that they don’t cover long-term care. This drives some people to pay out of pocket for costly assisted living fees, which may become unaffordable over time.
Those supporting elderly family members might even find themselves making large financial sacrifices in order to keep up with assisted living costs. For example, they might sell a car or move into a smaller home so they can provide the assisted living option.
But it’s not true that assisted living and insurance are completely incompatible. This article can help you get started in learning what kinds of things you can still get covered.
One possible solution here is something called long-term care insurance. This is a type of insurance that fills the gap left behind by some other, more common types of coverage.
Checking the Policy
Long-term care insurance is a smart decision for many people trying to figure out how to budget for assisted living, but it isn’t a magic fix. You will still have to read your explanation of benefits carefully to make sure it covers what you need it to.
For example, you might want to check whether your long-term care policy can stay intact even if the circumstances of your situation change. Some people move from assisted living to higher-care facilities over time, like nursing homes. If your insurance policy covers those as well, the transition in coverage will be much easier to deal with.
Perhaps the most important thing to look out for when settling on a long-term care insurance policy is whether the policy will accept the assisted living facility you use (or plan to use). Look for any requirements or standards your policy might have for what counts as an eligible facility for coverage.
For example, eligibility might depend on how many services the assisted living facility provides to its residents. Get this sorted out before you decide on an insurance company to move ahead with.
Medicare Limitations on Senior Solutions
Because Medicare is a system designed for people over the age of 65, we wouldn’t blame you for assuming this insurance would cover senior living facilities that incorporate nursing and other medical care.
And it’s true that Medicare can cover things like in-home nursing and rehab. But unfortunately, it does not cover long-term care facilities like assisted living.
If you or a loved one need to stay in an assisted living facility for a short time while recovering from an injury, you might be able to get this covered under Medicare. For a long-term stay, though, Medicare won’t be able to help you out.
Medicaid Limitations on Senior Care Solutions
Medicaid is a similar story to Medicare. It can cover some things, but it’s not a full solution. For example, Medicaid may be able to cover the nursing care component of an assisted living facility but not the room and board.
Does the assisted living facility you have in mind offer more comprehensive care than the typical facility? It could be good to ask whether the place has a Medicaid contract. If so, you could get more coverage than usual.
Get the Coverage You Need
Just because you or someone you support is in need of senior solutions doesn’t mean you have to go broke. The good news is that you’re finding out about your options early—and as long as you stay informed, you won’t be hit with a bill you didn’t see coming.
While both Medicare and Medicaid leave major gaps in assisted living coverage, you’ll likely be able to make up for this with long-term care insurance.
And for more articles to help you live a more informed life, check out the rest of this site!
