Will Medicare and Medicaid pay for long-term assisted living or a skilled nursing home? This is one of the most frequently questions aging families ask when they meet with our care managers. We wish we could give a simple answer, however, a complete explanation about federal and state benefits is a usually more complicated.
Medicare is health insurance available to adults age 65 and above and to individuals with certain disabilities.
Medicaid is a joint federal and state program that helps cover medical costs for individuals with limited income and resources.
When an aging adult no longer can safely live independently because he needs assistance with activities of daily living such as bathing, dressing, eating, toileting and ambulating or assistance with medication management, assisted living communities are sometimes the most appropriate choice. This person likely is already receiving Medicare benefits such as payments to doctors, partial costs for hospitalizations, rehab post-surgery or post-hospital stay for strengthening and coverage for prescription drugs. Most people are surprised to learn that Medicare does not cover the costs for assisted living expenses. In the same way that Medicare does not pay for a senior’s rent, mortgage, meals, etc., assisted living, also referred to as “room and board” costs are an individual’s responsibility.
Assisted living monthly costs range from $2,000 – $5,000+. For people that have sufficient retirement pensions, savings, or long-term care insurance, moving to a community is feasible. However, for many others that try to make ends meet with their Social Security income, assisted living costs are beyond their reach.
It is in these types of situations that Medicaid may be a solution. Medicaid is administered at the state level, and rules vary from state to state. In North Carolina, for 2016, general requirements are needed to qualify for Medicaid Special Assistance (assisted living or a memory care facility). Cash assets of less than $2,000 and a gross monthly income of less than $1300 are required for assisted living. Cash assets of less than $2,000 and a gross monthly income of less than $1580 are required for memory care facilities. If the individual applying for Medicaid has a spouse living in the home, the house and 1 vehicle are exempt from the asset limitation.