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Will Medicare Pay for My Care at a Residential Facility?

The short answer is no. Medicare does not pay for long-term care at a residential care facility. There is a lot of confusion about what Medicare actually covers, sadly enough. Essentially, Original Medicare (Parts A & B) is essentially catastrophic coverage. Original Medicare doesn’t cover quite a lot of the things we think we’ll need when we get older. This includes hearing aids, dentures, and long-term care.

We bet you’re thinking, “what is even the point of Medicare then?” We’ve all thought that from time to time. The important thing is to educate yourself and your friends and family so as to not be caught unaware. 

“​​Many people think that Medicare will pay for their long-term care expenses, but this usually is not true. Instead, people have to rely on their savings, long-term care insurance or Medicaid to cover the costs.” Texas Department of Health and Human Services

How Will I Pay for My Care at a Residential Facility?

When it’s time to move to a residential care home or assisted living, there is more to consider besides payment. You’ll need to downsize your belongings including furniture, clothing, and other personal items. Moving to a care home is a major downsize and moving is stressful for everyone. So it’s important to think about how to pay for your care home way before you need it. 

One of the ways to pay for assisted living is to use the assets from a home sale; though not ideal. In another article, we discussed the pros and cons of a reverse mortgage, which isn’t always the best option. This is why we think long-term care insurance is the best way to pay for your care at a residential facility. 

What is Long-Term Care Insurance?

Long-term care insurance and hybrid plans allow you to plan ahead for long-term care. It’s not always feasible to rely upon your adult children or grandchildren to take care of you when you’re elderly. If the average person needs 3 years of long-term care at $55k per year, it’s easy to see you’ll need just under $200,000 in savings or coverage with long-term care insurance. 

“The average person needs long-term care for 3 years, and 7 out of 10 people will need long-term care in their lifetime. Professional care can be a substitute for relying on your partner or family.” Fidelity

Long-term care insurance is about $2,200 a month says, Smart Assets, but considering increases in lifespan and overall health, it is a smart idea for most folks.

Does Medicare Pay for Help Around the House?

Maybe you’re not quite ready to move and you’d like a bit of help around the house. Will Medicare pay for that? Medicare only pays for services from a care home agency, not someone to do your laundry and shopping. This is when it’s time to start thinking about moving to a residential care facility. Temporary help (Medicare calls it “intermittent”) by skilled nurses is available when your doctor gives an outline for your recovery. 

“Medicare pays for you to get health care services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury.”  

Ready to Learn about Living in a Care Home?

Looking at residential care home options is overwhelming, we get it. We’d love to talk about your long-term goals and how to best meet the needs of your loved one or yourself. Let’s book an appointment for a conversation and a tour today.