Making Medicare Work for Assisted Living Residents

As a Medicare beneficiary, you may wonder about the program’s coverage of assisted living.

And as caregivers, we often have the difficult task of breaking the bad news: while Medicare can cover a limited stay in a skilled nursing facility and covers some home health care services, Medicare does not directly cover the cost of living in an assisted living community or long-term care services received in a nursing home. 

However, that’s not to say that there aren’t Medicare benefits that are helpful to residents of assisted living centers. While Medicare typically won’t help pay for your assisted living facility meals, activity fees or room and board, assisted living residents can utilize the following Medicare benefits to reduce their cost of living in an assisted living home or community. 

Medicare-Covered Health Services

Residents of assisted living homes still enjoy the same health care coverage as any other Medicare beneficiary. While Medicare does not cover the cost of residency or day-to-day custodial care provided by assisted living homes if that’s the only care you need, assisted living residents are in no way barred from receiving the same benefits as someone not living in an assisted living home or community. 

These standard Medicare benefits include the same inpatient care benefits and outpatient medical coverage that are part of Original Medicare (Part A and Part B) benefits.

Transportation

Some Medicare Advantage plans offer non-emergency medical transportation as an included benefit. That means if you have one of these plans, Medicare will cover the cost of your transportation to a doctor’s office, physical therapy appointment, pharmacy or other commute via taxi, public transportation or ride-sharing service. 

Telehealth

Medicare expanded its telehealth benefits at the onset of the COVID-19 pandemic. Telehealth, or telemedicine, allows doctors and other health care professionals to conduct virtual appointments via phone or computer which in turn allows patients to receive medical consultations without ever having to leave the comfort and safety of their assisted living facility or their own home. 

Skilled Nursing Stays

It’s not uncommon for residents of assisted living communities to have periodic stays in a skilled nursing facility (SNF) for rehabilitative care after an illness, fall or other injury. Medicare Part A covers skilled nursing facility stays along with the associated care.

Home Health Services

Medicare will pay for certain services provided right in your assisted living home such as:

• Intermittent skilled nursing care
• Physical and occupational therapy
• Speech language pathology
• Social services
• Intermittent home health aide services
• Injectable osteoporosis drugs 

Meal Delivery and Nutrition Services

Some Medicare Advantage plans can pay to have meals delivered right to your assisted living home following discharge from a hospital or other inpatient facility. Plans may also include nutrition services that cover meal supplements or discounts for healthy foods. 

Medicare can also help pay for nutrition therapy with a registered dietitian, depending on what health conditions you live with.

Prescription Drug Delivery

Many Medicare Advantage plans also provide coverage of mail-order prescription drugs so you don’t have to make a trip to the pharmacy to get the medications you need. 

Aging in Place Devices and Home Modifications

Another thing that is covered by some Medicare Advantage plans (but not covered by Original Medicare) is modifications to homes to help beneficiaries age in place. While some of these things will already be in place at an assisted living home (like wheelchair ramps and bathroom grab bars), others might be more reasonable such as air conditioners for people with asthma or medical alert systems. 

Adult Daycare

Should you need a break from the routine of your assisted living home, many Medicare Advantage plans will cover the cost of adult day care services. 

Talk to an Expert About Your Medicare Coverage

I encourage all residents of assisted living facilities and their loved ones to speak to a Medicare expert about their Part A and Part B coverage so they can best optimize their benefits according to their needs. Call 1-800-MEDICARE (1-800-633-4227) to connect directly with Medicare. You may also contact your state’s SHIP (State Health Insurance assistance Program) for free Medicare benefit consultation.

To learn more about the Medicare Advantage plans available where you live, you can compare plans online or contact a licensed insurance agent who sells plans in your area.