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Medicare's Home Care, Assisted Living and Nursing Home Benefits
| Definition |
Qualifications |
Costs |
| Pros & Cons |
Benefit Types & Limits |
How to Apply |
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| Overview of Medicare | ||
Medicare is a federal health insurance program for the elderly aged over 65. There are 4 parts, referred to as Medicare Part A, B, C & D.
1) Medicare Part A pays for inpatient hospital care, some skilled nursing, hospice, and home care (if prescribed). Part A is premium-free for 99% of beneficiaries.
2) Medicare Part B covers outpatient physician and hospital services, some home health services and medical equipment. Part B costs about $100 / month.
3) Medicare Part C allows private companies like HMOs and PPOs to offer health insurance that provide at least the same benefits of Parts A & B, but usually more like dental and vision. To manage costs, they offer a limited choice of providers.
4) Medicare Part D offers prescription drug benefits through private insurance companies at the cost of additional monthly premiums.
1) Medicare Part A pays for inpatient hospital care, some skilled nursing, hospice, and home care (if prescribed). Part A is premium-free for 99% of beneficiaries.
2) Medicare Part B covers outpatient physician and hospital services, some home health services and medical equipment. Part B costs about $100 / month.
3) Medicare Part C allows private companies like HMOs and PPOs to offer health insurance that provide at least the same benefits of Parts A & B, but usually more like dental and vision. To manage costs, they offer a limited choice of providers.
4) Medicare Part D offers prescription drug benefits through private insurance companies at the cost of additional monthly premiums.
Medicare is the primary medical care insurance for a large number of seniors. Many are shocked to discover that it does not cover costs for most types of long term care including Alzheimer's and dementia care. When it does pay, it is only in a very limited capacity. While Medicare is not a long term care solution, there are benefits for seniors with recoverable conditions on a short term basis.
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care for 20 days at a skilled nursing facility and 80% of the cost for 80 more days. The care must be for recovery following a hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care or the room and board cost of assisted living.
In Home Care
Medicare will cover skilled nursing care given in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined” meaning they are unable to leave the home without the assistance of another person.
Adult Day Care
Medicare does not pay for adult day care services.
Alzheimer's Care
Unfortunately, most care associated with Alzheimer's is considered personal care and therefore not paid for by Medicare. Medical care associated with Alzheimer's is covered. For very late stage Alzheimer's patients, there is a hospice benefit that may be applicable to Medicare beneficiaries. Read more about paying for Alzheimer's care.
Hospice
Medicare offers hospice coverage for terminally ill individuals whom doctors determine have less than 6 months to live. While Medicare hospice does not typically pay for room and board, it does cover medical expenses, prescription drugs and homemaker services which are typically not paid for by Medicare.
Skilled Nursing Facilities
Medicare will pay for 100% of the cost of care for 20 days at a skilled nursing facility and 80% of the cost for 80 more days. The care must be for recovery following a hospital stay.
Assisted Living Communities
Medicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care or the room and board cost of assisted living.
In Home Care
Medicare will cover skilled nursing care given in the home for a limited time period, but not non-medical care. Care must be prescribed by a doctor and needed part-time only. The senior must be “confined” meaning they are unable to leave the home without the assistance of another person.
Adult Day Care
Medicare does not pay for adult day care services.
Alzheimer's Care
Unfortunately, most care associated with Alzheimer's is considered personal care and therefore not paid for by Medicare. Medical care associated with Alzheimer's is covered. For very late stage Alzheimer's patients, there is a hospice benefit that may be applicable to Medicare beneficiaries. Read more about paying for Alzheimer's care.
Hospice
Medicare offers hospice coverage for terminally ill individuals whom doctors determine have less than 6 months to live. While Medicare hospice does not typically pay for room and board, it does cover medical expenses, prescription drugs and homemaker services which are typically not paid for by Medicare.
Since Medicare provides limited long term care benefits, we do not focus on the topic in depth. Visit this site for a comprehensive explanation of Medicare benefits.
Each state has a State Health Insurance and Assistance Program called SHIPs for short. These are staffed by volunteers that helps seniors with their Medicare, Medicare Advantage, Medigap and Medicaid benefits questions. Anyone with Medicare related questions can call a SHIP’s counselor even if they are not currently enrolled in Medicare. Learn more about SHIPs in your state.
Be Aware That:
Medicare does not pay for long term care at home, in assisted living and only for some of the cost for 100 days at a skilled nursing facility.
Medicare is Also Known As:
-Medicare Insurance Program
-Title XVIII of the Social Security Act
-Title XVIII of the Social Security Act
Age Requirements
Seniors are eligible for Medicare at age 65. They can receive Medicare at an earlier age only if they are entitled to Social Security disability benefits.
Disabilities / Health Requirements
There are no disability requirements to receive Medicare; however elderly persons with disabilities may be able to receive Medicare at an earlier age.
Family Status
There is no marital status or other family requirements to receive Medicare.
Financial Status Requirements
Seniors with any level of financial resources are eligible for Medicare. Seniors with limited financial resources may be eligible for Medicare Savings Programs.
Veteran Status Requirements
Medicare is available to both Veteran and non-Veterans.
Geographic Requirements
Medicare benefits are not available outside the US.
Types of Benefit Payout
Medicare benefits come only in the form of payments made directly to medical providers. Seniors do not receive cash payments.
Restrictions on How Payout Can be Used
Medicare benefits are restricted to direct payments to medical providers.
Benefits Amounts & Limits
Medicare benefits associated with long term senior care are as follows; Medicare will pay for 100% for 20 days of skilled nursing care and 80% for 80 more days.
Time to Receive Benefits
The average application processing time for Medicare across the US is 3 months.
This Source Can Help For
Short term residence at a skilled nursing facility.
For 99% of Medicare enrollees, Medicare Part A is a free service. In 2012, Medicare Part B costs most seniors a standard rate of $99 / month. For individuals whose Modified Adjusted Gross Income (MAGI) exceeds $85,000 / year, there are additional monthly fees.
There are no fixed rates for Medicare Part C and Part D. The costs depends on the plan in which the individual enrolls.
There are no fixed rates for Medicare Part C and Part D. The costs depends on the plan in which the individual enrolls.
Seniors are automatically enrolled in Medicare when they start receiving Social Security benefits. Medicare Part A is free for most but Part B has a premium associated with it and therefore seniors will be offered the opportunity to decline Part B. Seniors can postpone Social Security, but still enroll in Medicare when they turn 65, they can do so online, at a local Social Security office or by calling 1-800-772-1213.
Enroll in Medicare Online
Enroll in Medicare Online
