Medicare rules and regulations can be somewhat complex in determining what benefits are provided, such as long-term care. If you need to stay in a long-term care hospital or skilled nursing facility, Medicare does cover some of the costs of these services. However, if the type of long-term care you need can be found in an assisted living home—for help with daily living activities—Medicare does not cover any costs for this type of care.
Medicare Eligibility and Benefits
If you are 65 or older you are eligible for Medicare benefits. If you are under 65, you may still be eligible for Medicare if you meet special criteria, such as requiring dialysis for kidney failure or if you suffer from amyotrophic lateral sclerosis, ALS. The benefits you receive are divided into four categories: Part A – hospital care; Part B – doctor’s services; Part C – private insurance option; and Part D – prescription drugs. Regardless of whether you are in an assisted living home, if you are Medicare eligible you are entitled to these benefits.
Daily Living Activities
Assisted living homes serve the needs of people who are somewhere between independent living and requiring nursing home care. The primary purpose for an assisted living home is to help its residents with daily living activities, such as meal preparation and eating, personal hygiene, taking medicine and traveling to important appointments. On a day-to-day basis, a resident of an assisted living home does not require the type of medical care provided in a skilled nursing facility or hospital, whether acute care or long-term care. Therefore, Medicare does not pay for the expenses associated with an assisted living home.
Medicaid, SSI and Housing Programs
Due to Medicare’s limitations, most assisted living homes require private payment. However, there may be other assistance programs for this payment. Some states offer assistance with payment through Medicaid or Supplemental Security Income, if you qualify for these programs due to low-income and other medical needs. Because the type and availability of such assistance varies greatly from state to state, the only way to determine whether you qualify is to submit an application for benefits with your state’s Medicaid office.
