Does Medicare Pay for Assisted Living?
Entrusted Legacy Law
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Dec 29, 2022
Pennsylvania - Greater Pittsburgh Area
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Assisted living facilities support older adults with daily living while fostering their independence. Individuals who do not require round-the-clock nursing but need help with everyday activities like bathing, housekeeping, medications, and meal preparation can benefit from assisted living.
Some seniors choose to move into assisted living following a frightening event, such as a fall. They want to live autonomously but may feel unsafe in their homes.
Averaging $4,500 per month, assisted living can be expensive. Those considering assisted living might wonder whether Medicare, a federal health insurance program for qualifying adults aged 65 or over, will cover the cost.
Traditional Medicare covers only certain health services to those residing in an assisted living facility. Meanwhile, some Medicare Advantage programs may only pay for services that help people remain in their homes.
Does Traditional Medicare Cover Assisted Living?
In short, no. While traditional Medicare supports older adults’ medical needs, it does not apply to most assisted living expenses. Assisted living facilities help residents with everyday, nonmedical tasks, which Medicare typically does not include.
Medicare Part A insures people for hospital stays and up to 100 days in a skilled nursing facility. Skilled nursing facilities provide 24-7, short-term nursing care. Because they deliver medical care, they are distinct from assisted living facilities, which offer custodial or daily life care.
Medicare Part B pays for medical fees for outpatient care, and Part D covers prescription drug costs. Most assisted living expenses do not fall under Medicare Part A, B, or D.
However, traditional Medicare may cover specific medical costs for people in assisted living. Expenses Medicare may cover include:
- Physical therapy
- Specific health services like changing sterile dressings
- Preventative health services like vaccinations
- Health care transportation
Does Medicare Advantage Pay for Assisted Living?
Private insurance companies that contract with traditional Medicare sell Medicare Advantage plans. Like original Medicare, these plans typically do not cover monthly assisted living bills.
Certain Medicare Advantage plans may offer supplemental home care benefits that help people continue living independently, albeit in their own homes rather than a designated facility.
The services available through select Medicare Advantage programs may include home modifications like wheelchair ramps and bathroom safety grab bars; in-home assistance with daily tasks; and transportation to the hospital and the pharmacy. Adult daycare is also available through some Medicare Advantage plans.
Seniors looking to live on their own might consider enrolling in a plan that includes services that support autonomy. Many programs are available, and the coverage that is open to you depends on where you live. The terms of Medicare Advantage plans vary. Review your plan options and speak with an attorney before deciding whether to enroll in a Medicare Advantage program.
Does Medicaid Pay for Assisted Living?
Unlike Medicare, Medicaid generally will pay for some of the costs of assisted living. Medicaid is a joint federal-state health insurance program for low-income people, including older adults. Although it does not cover room and board for assisted living, it may help pay for personal care services, on-site therapy services, and medication management.
Before deciding whether to move into an assisted living facility, speak to us.
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Many married couples share almost everything, including finances. This may be reflected in their estate plan by using one joint living trust instead of two separate trusts. Separate trusts can provide greater flexibility, but a joint trust can be structured so that when one spouse passes away, the trust is split into two sub-trusts: a survivors trust and a decedents trust. This arrangement provides the surviving spouse with the same versatility that separate trusts offer. The surviving spouse has full control over their survivors trust, but may have limited control over the deceased spouses accounts and property that make up the decedents trust. Decedents Trust and a Survivors Trust A survivors trust is a middle ground between a joint trust and separate trusts. If a couple chooses to combine their assets (accounts and property) into a joint revocable living trust, both spouses will usually be named as trustees and beneficiaries. The joint trust can further stipulate that when one spouse passes away, the trust divides into subtrusts. One of those subtrusts can be a survivors trust. A second subtrust, the decedents trust, will also be created to hold and manage assets owned by the decedent. How a Survivors Trust Works A typical joint trust arrangement lists four types of property, depending on the state in which you live: Joint assets Community property First spouses separate property Second spouses separate property When the first spouse dies, the survivors trust receives one-half of the community property, one-half of the joint property, and all property identified as the separate property of the surviving spouse. The deceased spouses half of the community property and joint property, along with their separate property, may be funded into the decedents trust with its own set of instructions. The trust agreement could also state that all of the deceased spouses property will go into the survivors trust instead of going into a separate subtrust. Reasons to Have a Survivors Trust Regardless of exactly how the joint trust assets are allocated, a crucial distinction is that a survivors trust is revocable, while the decedents sub-trust is irrevocable. This means that the surviving spouse retains full control over the survivors trust. They can alter the terms of the trust however they want. For example, they can add and remove assets, change beneficiaries, appoint new trustees, or terminate the trust. The surviving spouse can also completely change the terms of the survivors trust in its entirety. While the surviving spouse may be the beneficiary of the decedents trust, the surviving spouse will likely have less control over the management of assets in the decedents trust. This allows the deceased spouse to put protective measures in place while they are alive to make sure that their assets are managed the way they want and that someone cannot change the rules after they pass away. This can be helpful for clients who are worried about their spouse remarrying after their death and to ensure that assets that remain at the surviving spouses death go to a predetermined person. The purpose of any trust is to take care of loved ones and protect assets from costly probate and taxes. To discuss an estate plan that meets your goals, please schedule your appointment with our Estate Planning attorneys - 724-375-4005.
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