When seriously considering senior living options outside the family home, a chief question is, “Who pays for it?” Many people think Medicare will pay either the entire cost or a good portion of it, so discovering how limited these benefits truly are before they’re actually needed helps older adults and their families avoid confusion. Be smart: Get the facts about Medicare, Medicaid and Veterans Benefits now.
In general, Medicare doesn’t pay for home care or senior living. It only pays for medically necessary care. This is an eye-opener for many families just beginning to explore how they’ll pay for senior care.
What Medicare Will Pay For
- Short-term rehabilitation in a skilled nursing and rehab center. If a senior meets several required conditions, Medicare will pay for a portion of the first 100 days of rehab. The first 20 days are covered in full; a co-pay is then required for days 21-100.
- Skilled home health care services from a Medicare-certified agency. These services are most often used following a hospital stay for an illness, injury or surgery. Skilled nursing care, physical therapy, speech therapy or occupational therapy services are delivered in the privacy of the senior’s home, whether that’s their private residence, or their residence in an independent living or assisted living community. But it’s important to understand that, while Medicare will pay for home health services in an assisted living residence, it doesn’t pay for the costs of room and board. Furthermore, these benefits are limited, not open-ended.
Here’s what Medicare won’t pay for:
If you were hoping Medicare would help finance a stay in an assisted living or memory care community, unfortunately it won’t. Any care considered “custodial” in nature isn’t covered by Medicare. This includes personal care (bathing, dressing, continence care, etc.), as well as medication reminders and other activities of daily living.
If an older adult meets the eligibility requirements, Medicaid will help pay for:
- Long-term care in a nursing home
- Skilled home health care services in a senior’s private home
- Short-term respite in a nursing home
Here’s what Medicaid pays for in some states
Medicaid is a federal program, but managed at the state level. States are obligated to provide support for certain special populations, but may expand coverage beyond those. In some states, Medicaid helps pay for:
- Medicaid waiver programs to help cover assisted living care
- Home-based community services for seniors who live at home
Veterans Aid & Attendance Benefit
Veterans and/or their surviving spouse who require the aid and attendance of another person may be eligible for additional assistance beyond their normal pension amount. This benefit can help pay for long-term care costs, including assisted living, home care, adult day services and a nursing home.
In 2015, the maximum Aid & Attendance awards are:
- $21,446 for a veteran
- $25,448 for a veteran with one spouse or dependent
- $2,198 for each additional dependent child
- $13,794 for the surviving spouse of a qualifying veteran
From eligibility to the application process, here’s what you should know.
Aid & Attendance Benefit Eligibility
The veteran must have served at least 90 days of active duty, and one of those days must have been during a period of active war, as defined by the Veterans Administration:
- World War II (12/7/1941 through 12/31/1946)
- The Korean Conflict (6/27/1950 through 1/31/1955)
- Vietnam War (8/5/1964 through 5/7/1975; Veterans who served in Vietnam beginning 2/28/1961 may also qualify)
- Gulf War (Beginning 8/2/1990, with end date not yet determined by Congress)
The veteran or their surviving spouse must meet the “countable income” requirement. Countable income can include income from pension payments, disability payments, interest and dividends from investments. The VA also considers assets and expenses when determining eligibility.
Advice from an Elder Care Expert
If these programs aren’t an option, there may be other avenues for support. Reverse mortgages, senior care credit lines, home settlement companies and long-term care insurance are among them. We advise speaking with a financial professional or elder law attorney experienced at helping families fully understand the options that may help close the gap in financing senior living care.