Does Insurance Cover Assisted Living?

Assisted living is a great option for seniors who need assistance with daily activities such as dressing, eating, or medication management but don’t require around-the-clock medical care. However, many people find themselves wondering whether their insurance covers the cost of assisted living. In this article, we will take a look at the different types of insurance that may cover assisted living, what is typically covered, and what to expect when it comes to out-of-pocket costs.

Types of Insurance That May Cover Assisted Living

There are a few different types of insurance that may cover the cost of assisted living, including:

Let’s take a closer look at what each of these types of insurance covers.

Long-Term Care Insurance

Long-term care insurance is a type of insurance policy that helps cover the costs of long-term care, including assisted living. However, not all long-term care insurance policies are the same, and the coverage can vary widely depending on the policy. Some policies may cover all of the cost of assisted living, while others may only cover a portion of the cost.

When considering a long-term care insurance policy, it’s important to read the fine print and understand what is covered and what is not. Some policies may have restrictions on the type of care covered or the length of time that the policy will pay for care.

Medicare

Medicare is a federal health insurance program that provides coverage for people who are over the age of 65 or who have certain disabilities. While Medicare does cover some medical expenses, it does not typically cover the cost of assisted living.

However, Medicare may cover some of the medical costs associated with assisted living, such as doctor visits, lab tests, and medical equipment. Medicare also covers short-term stays in a skilled nursing facility for rehabilitation purposes, which may be necessary after a hospital stay.

Medicaid

Medicaid is a joint federal and state program that provides health insurance for people who have limited income and resources. While Medicaid does not typically cover assisted living, it may cover some of the costs of long-term care in a nursing home or other type of facility.

Some states have Medicaid waiver programs that allow Medicaid to pay for assisted living for people who meet certain eligibility criteria. These programs vary by state and may have waiting lists.

Veterans Benefits

Veterans benefits are available to veterans and their surviving spouses who meet certain eligibility criteria. The Department of Veterans Affairs (VA) offers a variety of programs that may cover the cost of assisted living for eligible veterans and their spouses.

The VA Aid and Attendance program, for example, provides financial assistance to help cover the cost of assisted living for veterans who need help with daily activities such as bathing, dressing, and eating. To be eligible for this program, veterans must have served at least 90 days of active duty, with at least one day during a wartime period.

What Is Typically Covered by Insurance?

When insurance does cover the cost of assisted living, it typically covers the following:

• Room and board
• Assistance with activities of daily living (ADLs) such as bathing, dressing, and eating
• Medication management
• Social activities and recreational opportunities

However, it’s important to note that the specific services covered may vary depending on the type of insurance and the policy details.

What Are the Out-of-Pocket Costs?

Even if insurance does cover the cost of assisted living, there may still be out-of-pocket costs. These can include co-pays, deductibles, and any costs that exceed the coverage provided by the insurance policy.

If insurance does not cover the cost of assisted living, the out-of-pocket costs can be significant. According to Genworth’s 2020 Cost of Care Survey, the average cost of assisted living in the United States is $4,300 per month.

FAQ

Q: Does Medicare cover the cost of assisted living?

A: Medicare does not typically cover the cost of assisted living.

Q: Does Medicaid cover the cost of assisted living?

A: Medicaid may cover some of the costs of long-term care in a nursing home or other type of facility, but it typically does not cover the cost of assisted living.

Q: Can long-term care insurance be used to pay for assisted living?

A: Yes, long-term care insurance can be used to pay for some or all of the cost of assisted living, depending on the policy.

Q: How much does assisted living cost?

A: According to Genworth’s 2020 Cost of Care Survey, the average cost of assisted living in the United States is $4,300 per month.

Q: Are there any government programs that can help pay for assisted living?

A: Yes, there are some government programs, such as Medicaid and Veterans Benefits, that may help pay for the cost of assisted living for eligible individuals. However, these programs typically have strict eligibility criteria and may have waiting lists.

Q: What services are typically covered by insurance when it comes to assisted living?

A: When insurance does cover the cost of assisted living, it typically covers room and board, assistance with activities of daily living (ADLs) such as bathing, dressing, and eating, medication management, and social activities and recreational opportunities.

Conclusion

Assisted living can be a great option for seniors who need assistance with daily activities but don’t require around-the-clock medical care. While insurance coverage for assisted living can be complicated, it’s important to understand the different types of insurance that may cover the cost and what is typically covered. Remember to read the fine print when choosing a long-term care insurance policy or exploring government benefit programs, and be prepared for potential out-of-pocket costs.