Introduction

Are you wondering if Medicare will cover the care you need? One of the most common questions those looking for senior and assisted living are asking is whether or not Medicare pays for assisted living communities. The answer is not simple because it depends on many factors. Keep reading to learn about the things many don't know about Medicare.

To understand how Medicare benefits work, you first need to know a little about the program. Medicare is our country's health insurance program for people 65 and older, people under age 65 with certain disabilities, and people of any age with end-stage renal disease (ESRD). These two articles may be of interest to you. 17 Ways to Afford Assisted Living and The Cost of Senior Living

Choosing a Medicare Plan

Choosing the right Medicare plan is crucial because it can affect the type of living and care options you or your loved one will have. Suppose financial assistance will be needed to offset assisted living costs and long-term care. You'll be left wondering if Medicare will pay for assisted living in the home and assisted living facilities.

While Medicare can be a simple process for some people, it can be riddled with many options for others. Considerations include personal care needs, preferences, medical care, and Medicare's various options. You can learn more on their website.

Here are 10 Things You Probably Didn't Know About Medicare

1. Medicare does not necessarily cover assisted living. Medicare won't cover assisted living unless a person is discharged from a hospital stay and into a nursing facility or nursing home. Their discharge stay into these facilities is short and based on a Medicare timeline or allowance.
2. Medicare has four parts: Part A, Part B, Part C, and Part D.
3. Part A is hospital insurance that covers inpatient care in hospitals, nursing facilities, hospices, and home health care (if a doctor orders it).
4. Part B is medical insurance that covers outpatient care, preventive services, durable medical equipment, and some home health care (again if ordered by a doctor).
5. If a person needs outpatient rehabilitation services after a hospital stay, Medicare Part B (medical insurance) will cover some of the costs if the services are provided by a Medicare-approved facility.
6. You must be a U.S. citizen or a legal permanent resident of at least five continuous years to qualify for Medicare benefits.
7. If you are still working, you may be able to get Medicare benefits through your employer's group health insurance plan.
8. You can also qualify for Medicare if you are a younger person with a disability or End-Stage Renal Disease.
9. For Medicare to cover the cost of assisted living, you must be under the care of a doctor, or your doctor must certify that you need skilled nursing or rehabilitation services intermittently.
10. If you meet the criteria, Medicare will cover a portion of the costs of your care. However, you will still be responsible for paying your deductible and a co-payment for each day you receive skilled nursing or rehabilitation services.

Now that you know some of the basics of Medicare, let's delve into the details.

Medicare is More Complicated than Standard Health Insurance Plans

You should know and understand Medicare's four parts: Part A, Part B, Part C, and Part D.

Part A

This is the essential free part of Medicare. Part A covers inpatient hospital care, skilled nursing facility care, home health care, and hospice care. It covers basic medical needs such as doctor visits, inpatient hospital or outpatient care in skilled nursing facilities or a nursing home, and hospice. It will also pay for hospice offered in a senior's home, including if they live in an assisted living community. Hospice services may include some personal care services, some of which include physical therapy and occupational therapy.

Part B

Part B, known as the Medigap Plan, covers outpatient care, preventive services, and dental and vision services.
It covers medically necessary diagnostics, treatments, and preventative services, and an additional premium, usually monthly, ranging from $135 to $450, must be paid.

Part C

Part C, also known as Medicare Advantage, gives beneficiaries the option to receive their benefits through a private insurance company rather than through Original Medicare.

If you choose to receive your benefits through a Medicare Advantage Plan, you will generally have to pay a monthly premium to the insurance company in addition to your Part B premium. You may also have to pay copayments and coinsurance for the care you receive.

Part D

Part D is also known as Prescription Drug Coverage. This covers prescription drugs for an additional $32.50 per month. There are some exceptions, such as drugs used for cosmetic purposes, over-the-counter drugs, and some vitamins and minerals.

(For more information on the different parts of Medicare, click here.)

The Time Frame to Apply is Short

You have seven months to register for Medicare without paying penalties. You should register three months before your 65th birthday. Although enrollment may happen automatically for some people, it is best to look into it before you turn 65 to be certain.

Dental, Eye, and Hearing Aren’t Covered Under Medicare

You will need to get additional policies to cover most dental, eye, and hearing needs or pay out of pocket. Some conditions or circumstances will cover services or types of care, such as glaucoma or procedures that occur during a hospital stay.

Does it Cover Long-Term Care Insurance Needs or Assisted Living Facilities?

Medicare does not cover costs or care for assistance with day-to-day activities such as assisted living community costs or in-home care costs. It is important you understand the cost of assisted living early on in order to financially plan accordingly.

You Have to Enroll in Medicare

Some people may think they can continue their standard medical insurance instead of Medicare. However, most policies in the marketplace for standard insurance will have terms and conditions about this. It can result in extra fees, penalties, and costs on both the traditional insurance side and with the Medicare policies.

You Can Get Help

Medicare can be complicated to figure out, especially if you have unique circumstances or conditions or are in financial need. Some advisors can help you navigate enrolling in Medicare and decide the best option for additional plans and policies. Sites such as Medicare Rights and Medicare Interactive can offer help free of charge.

How Do I Sign Up For Medicare?

If you are already receiving benefits from Social Security or the Railroad Retirement Board, you will be automatically enrolled in Medicare Part A and Part B. You will receive your Medicare card in the mail about three months before your 65th birthday.

If you are not receiving benefits from Social Security or the Railroad Retirement Board, you can sign up for Medicare online, by calling 1-800-MEDICARE (1-800-633-4227), or by contacting your local Social Security office.

You can also sign up for Part A and/or Part B during the seven-month period that begins three months before the month you turn 65, includes the month you turn 65 and ends three months after the month you turn 65.

If you wait to sign up for Part B until after you are already enrolled in Part A, you may have to pay a late enrollment penalty.

You can sign up for Part C (Medicare Advantage) and/or Part D during the annual open enrollment period from October 15th to December 7th each year.

If you are already enrolled in Original Medicare, you can switch to a Medicare Advantage Plan during this time. If you are not enrolled in Medicare, you can sign up for both Part A and Part B, a Medicare Advantage Plan or a stand-alone Part D plan, during the annual open enrollment period.

Things to Consider

When choosing a Medicare plan, consider a few things, such as whether you want the original Medicare or a Medicare Advantage Plan, what type of coverage you need, and what you can afford to pay.

If you have questions about Medicare or need help choosing a plan, you can contact the Medicare helpline at 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. You can also contact your local Social Security office.

Medicare and Medicaid are Different

Aside from Medicaid being need-based, the two have several other differences. As it pertains to seniors, one significant difference is that Medicaid payment and qualified Medicaid services vary between states. Therefore, the benefits of programs, level of assistance, and qualifications vary greatly depending on where you live.

Medicare Changes

You read that right; the costs and coverage change annually—and costs are rising. What you budget today for medications, deductibles, and care coverage could look very different five years from now. However, this year, they simplified it by limiting the number of additional plans to 8 from 10 (Medicare).

Medicare Monitors Quality

Medicare must qualify providers to accept Medicare payments and plans. Plan providers are also monitored. Medicare thereby rates the facilities, providers, and health insurance plans. Search for all of these on the website and find the best value for your policies and the best care.

You Can Change it Up

Every year, you have a window of time to change your Medicare policies. Today's best coverage and policies may not be best for you in 10 years, so look into your options and change them to suit your lifestyle and medical needs as needed.

Does Medicare Pay For Assisted Living?

There are a few other circumstances in which Medicare might help pay for some of the costs related to assisted living, but they are rare. For example, if someone receives hospice care in an assisted living facility, Medicare Part A (hospital insurance) will cover certain related costs.

In addition, if a person needs outpatient rehabilitation services after a hospital stay, Medicare Part B (medical insurance) will cover some of the costs if the services are provided by a Medicare-approved facility. However, these circumstances are generally the exception rather than the rule when it comes to Medicare coverage of assisted living costs. This means that if you or a loved one is considering an assisted living facility, you will likely have to pay for the costs yourself or look into other financing options, such as long-term care or loans on life insurance.

The person must also require custodial or skilled care while in the facility. Custodial care involves help with activities of daily living such as bathing, eating, and dressing, and nursing care is provided by a licensed nurse.

Conclusion

Picking the right Medicare insurance plan is tough if you don't know the basics of Medicare. With these 10 things you probably didn't know about Medicare, you'll be able to make an informed decision on the health care you or your loved one needs.