The most common surprise for families is that Medicare does not pay for assisted living. Medicare covers medical care, and assisted living is mostly personal care and housing. Here is how families usually cover the cost.
1. Private pay
Most assisted living is paid from savings, retirement income, Social Security, pensions, or the proceeds from selling a home. Ask each community exactly what the monthly rate includes. Many charge a base rent plus a separate fee for the level of care, and that care fee can rise as needs change.
2. Long-term care insurance
If your loved one bought a long-term care policy, find it now and read the benefit triggers, the daily or monthly benefit, and the elimination period (the waiting period before benefits begin). Policies usually pay once a person needs help with a set number of daily activities or has a cognitive impairment.
3. Veterans benefits
Wartime veterans and surviving spouses who qualify for a VA pension may be eligible for an added monthly amount called Aid and Attendance if they need help with daily activities. Eligibility depends on service dates, income and net worth. A VA-accredited representative can help you apply at no charge.
4. Medicaid, depending on the state
Medicaid rules for assisted living vary widely by state. Many states use home and community-based services waivers to help pay for care services in assisted living for people who qualify financially and medically. Medicaid generally does not pay the room and board portion, and waiver programs can have waiting lists. Your state Medicaid office or local Area Agency on Aging can tell you what exists where your loved one lives.
5. Other sources families combine
- Family contributions, sometimes shared among siblings.
- Life insurance with a living benefit or long-term care rider.
- Renting out a home instead of selling it.
Rules on Medicaid eligibility and asset transfers are complex and differ by state. For decisions involving property or savings, an elder law attorney is worth the consultation fee.
Questions to ask every community about cost
- What is included in the base rate, and how is the care level assessed and priced?
- How much have rates gone up in each of the last few years?
- Is there a one-time community or move-in fee?
- Do you accept Medicaid waiver payments, and what happens if my loved one runs out of private funds?
Not sure which kind of care fits? A Grace With Care guide can talk it through with you. Tell us about your loved one or call 855-330-2200.
Sources
- Medicare.gov: Long-term care
- Medicaid.gov: Home and community-based services
- VA: Aid and Attendance benefits and Housebound allowance
This guide is general information, not medical, legal or financial advice. Coverage rules change; confirm details with the program or your plan.
