Author: Tiffany Stockton
Reviewed By: Gene Altaffer

Blue Cross Blue Shield approaches assisted living coverage by offering exceptions to standard coverage when required medical care exists. BCBS offers Medicare Advantage, Medigap and standalone Medicare Part D plans. These policies rarely cover assisted living or other types of long-term care, but some coverage may exist through specialized plans and long-term care insurance. Contact your preferred BCBS insurance company to discuss available options for your specific needs.

Considerations for Blue Cross Blue Shield assisted living coverage

BCBS operates as a group of independent health insurance companies under the Blue Cross Blue Shield Association, so coverage for assisted living services varies among individual companies. Some state regulations require and make available specific types of coverage, while others let the insurance companies decide. If a health care professional deems assisted living medically necessary, it may increase the likelihood of coverage. This includes administering medication and providing routine assistance with ADLs.

Available long-term care insurance plans may require pre-authorization or approval before covering assisted living services. Policies may also have waiting periods or a list of specific medical services they will cover. Review the policy documents thoroughly to understand what the policy covers, and then follow any required procedures.

Documenting medical necessity for assisted living coverage

To secure coverage through a BCBS insurance company, you’ll need a health care professional to deem your assisted living services as medically necessary. Provide detailed medical records, including any chronic conditions, disabilities or diagnoses that impact your ability to perform ADLs independently. Clearly document functional limitations, emphasizing any challenges in mobility or prescribed treatment plans that necessitate the level of support provided in an assisted living setting.

Clearly articulate the need for assisted living over other care settings, and ensure consistency in all documentation. Once you have obtained the certification in writing, reach out to BCBS, and use the search tool to shop for insurance and see which plans are available in your area. BCBS coverage varies by state, so the application process differs for each individual. You will be able to enroll online or by phone with a licensed agent.