Can Medicare Supplement Insurance Plans Be Used to Pay for Assisted Living?
Medicare supplemental insurance policies are designed to help seniors pay for services that ordinary Medicare benefits don’t cover. Sometimes called Medigap policies, these privately issued insurance plans can help close the large gaps in coverage that would otherwise leave some seniors with no way to get the care they need. No currently authorized Medigap policy includes coverage for assisted living, though seniors who need financial help with the cost of residential care may still have options.
Medigap and Assisted Living
Medigap plans exist to help Medicare beneficiaries pay for services that Original Medicare leaves uncovered. Vision, dental and some prescription drugs are typically included in most Medicare supplemental policies. Residential care, such as short-term stays in nursing care homes and post-acute rehabilitation facilities, are partly paid for by Medicare Part A and many Medigap insurance plans. Memory care and hospice stays may also be included as Medicare or Medigap benefits. Together, these policies can bring some medically oriented residential care services into the price range of many seniors.
Assisted living is different from other forms of residential senior care. Because the services offered by assisted living facilities are not primarily medical in nature, despite medication management and care coordination with residents’ physicians, Medicare and the insurance companies that offer supplements do not pay for them. These programs also do not usually cover the cost of alternatives to assisted living, such as in-home caregiver assistance and adult day health services.
Paying for Assisted Living
Medicare and Medigap are not the only resources available for seniors who need help with the cost of residential care. Seniors with limited income and assets often choose Medicaid as their Medicare supplement. Though Medicaid also does not pay for long-term care in assisted living, beneficiaries in many states can sign up for an assisted living waiver program.
Medicaid assisted living waivers pay some or all of the monthly cost of assisted living for seniors who qualify to get them. Though eligibility varies from state to state, most waiver plans offer a voucher for assisted living when the alternative is for the beneficiary to move into a residential nursing care facility. By offering to pay for the less expensive care that assisted living offers, state Medicaid waivers can reduce the cost of care for both the Medicaid program and for the seniors who need help paying for their stay in a high-quality assisted living facility.