Is Assisted Living Covered by Health Insurance?

The United States, like many other developed nations, has seen an increase in elderly citizens. As a result, demand for assisted living and other forms of elder care has increased significantly in recent years. This trend is sure to continue, and it has many families wondering how to pay for assisted living. Health insurance may cover some of the expenses associated with care for the elderly, but to minimize costs, families must look for multiple sources of support.

Is Assisted Living Covered by Health Insurance?

Elder Care Costs

Assisted living is expensive. Although the cost varies from state to state in keeping with the average cost of living, the national average is around $4,300 a month. It should be noted that assisted living is more affordable than a nursing home, which provides a greater degree of assistance and has qualified medical personnel on hand at all times. In either case, most elderly residents in these facilities will remain there for an average of two to three years.

When you consider the average cost and average time spent in such facilities, families may face costs of over $120,000 for assisted living alone. This expense often forces elders to use a significant portion of their retirement savings or social security benefits. However, insurance can alleviate some of the financial burden on families in this situation.

What Will Insurance Cover?

Medical insurance plans may cover a portion of the costs associated with assisted living or nursing homes, but it depends on the situation. In general, insurance is more likely to cover the costs of assisted living when a doctor calls for a stay in an assisted living facility. For example, after a major operation like a hip transplant, a doctor may recommend that the patient spend several months in an assisted living facility to make rehabilitation easier.

When a doctor prescribes assisted living, insurance companies may be able to cover the costs if there is an in-network facility nearby. However, few insurers have in-network facilities, and doctors often recommend short stays. The end result is that insurance rarely covers enough of the cost.

Medicaid Covers Assisted Living

Although Medicare will not cover assisted living costs, Medicaid does. The exact amount varies from state to state, but Medicaid can significantly reduce the cost of assisted living or nursing home care. Coverage includes essential services like nursing and rehabilitation, along with dietary services and room maintenance. Personal comforts like clothing or amenities like a TV may not be covered.

Combine Your Sources

The best way to pay for assisted living is to pool resources from a variety of sources. Medical insurance can cover intervention from doctors and prescription medications. Medicaid can help with assisted living costs. Withdrawing funds from certain life insurance plans or retirement benefits can lessen the burden as well without destroying one’s entire nest egg.

If you need help enrolling in government programs like Medicare or Medicaid to get benefits for assisted living, contact Brooker Medicare to speak to one of our experts.

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