Medicare beneficiaries have the option to stick with Original Medicare for their healthcare services or to enroll in a Medicare Advantage plan. Advantage plans cover all of the same services as Medicare Parts A and B and can also include some extra benefits that Medicare doesn’t.
Medicare Advantage plans do not cover assisted living costs, but some Advantage plans do now include benefits that are related to long-term services, such as in-home patient support, home safety modifications, and adult day care services.
This came about due to some legislation passed in 2018 allowing Advantage plans to offer supplemental home services that will benefit chronically ill people. Let’s take a look at what has developed and how it’s different from what Traditional Medicare covers.
Traditional Medicare and Long-Term Care Overview
Original Medicare covers inpatient care under Part A. This includes acute hospital care, skilled nursing care, and hospice benefits.
After you’ve had a qualifying inpatient hospital stay, Part A will pay for stay in a skilled nursing facility (SNF), but only a short-term basis. This stay is capped at 100 days. After that, you pay entirely out-of-pocket.
This SNF care is intended to help you recover and get back on your feet after a medical injury, illness, or procedure. So, while this care is very appropriate for someone recovering from a joint replacement or even a stroke, it is not intended to care for people who are not likely to recover.
For example, if you have dementia and are not likely to return to being able to live independently, then you will transition to long-term care that you must pay for yourself.
Medicare Advantage Plans and Long-Term Care
Medicare Advantage plans must also cover up to 100 days in a skilled nursing facility, just like Original Medicare. However, Advantage plans have always been able to include some extras like routine dental and vision care.
Going forward, they will now also be able to include supplemental home care benefits. While these are certainly not the same as full-time assisted living or nursing home care, they may help beneficiaries to remain living independently in their own homes for a longer period of time before moving into full-time assisted living.
Each Medicare Advantage insurance company can include these benefits at their own discretion. That means that some plans will offer these kinds of supplemental home care benefits and others will not.
Some of the non-medical, supplemental home health-related benefits you may begin to see some plans including are:
Modifications to Improve Home Safety
People often move into assisted living after they have had a fall or more difficulty getting around their own home. With this in mind, Advantage plans will now be able to offer installation of wheelchair ramps and bathroom safety grab bars. Other examples would be special air conditioners for people with breathing disorders.
The hope is that if more people are able to afford these kind of home improvements, that there will be fewer medical emergencies and elderly individuals might be able to continue living at home for a longer period of time before assisted living becomes necessary.
Personal Care Services in Your Own Home
Generally, when people move into long-term care, it’s because they are no longer able to handle own activities of daily living like bathing, getting dressed, basic hygiene, and preparing and eating their own food. Advantage plans will be able to help by offering in-home support services for a certain amount of time each week or month.
If home health aides could assist beneficiaries with some of these basic tasks as well as things like cooking and cleaning, then the Advantage plan insurance carrier may end up spending less on medical treatment.
Transportation and Nutrition Support
There are some Medicare beneficiaries who may no longer be able to drive and do not have access to other affordable means of transport. However, they are still able to live independently for the most part.
Advantage plans will now be able to offer transportation services on a limited basis to help these individuals get to and from medical appointments and to pick up prescriptions from the pharmacy. Plans can also include delivery of hot meals to the individual at home.
Each plan will be different in how often they provide these services so be sure to check the details on these services before you enroll.
Adult Day Care
Adult Day Care services have become tremendously popular over the last decade. This care is intended to give full-time caregivers a break or time to run other errands. The member can still receive proper care in a very safe environment.
Day care centers for adults typically operate five days a week, but some may also offer services on weekends. Social interaction is a big focus for many of these facilities and the beneficiary receiving the day care may participate in crafts, exercise, games, and music therapy among other activities. Some centers may focus on medical care and/or memory care for patients as well.
With the new legislation in place, we expect to see that some Advantage plans may begin to incorporate adult day care services into their plan designs. Even if an Advantage plan only offered a few days per month in adult day care, it would be a huge help to caregivers.
Over the Counter Allowances
While many Medicare Advantage plans include Part D medications, they do not usually include over the counter medications. Advantage plans can now begin to offer monthly or quarterly benefits that members can use to purchase vitamins, pain relievers, allergy medicines and other over the counter products.
These will usually be offered in some sort of catalog that members will receive and they’ll have a set allowance to spend on these items.
It can sometimes be challenging for older people to make the trip to their medical provider’s office, especially if they have chronic illnesses. Advantage plans will now be able to incorporate new telehealth services that will allow members to consult their doctors via video calls on their smartphones.
The Big Picture
What we are seeing in these Medicare Advantage improvements is that the U.S. healthcare industry is beginning to step away from the idea of treating patients only when they are very ill. Instead they will focus on trying to prevent them from getting that ill in the first place.
Insurance companies are beginning to realize that many other factors play into patient outcomes. The environment and community in which a Medicare beneficiary lives and interacts can play a critical role in how much medical spending that person’s insurance company ultimately incurs on their behalf.
Will All Medicare Advantage Plans offer these benefits?
There are literally thousands of Medicare Advantage plans across the country and not all of them will include all of these benefits. Instead, we can expect to see more plans beginning to include some of these benefits in 2020 and beyond.
So, if supplemental home benefits are important to you, then you’ll want to research plans available in your area and then review these plans’ Summary of Benefits to see what kinds of support benefits are written into the plan design.
How to Pay for Assisted Living
We don’t anticipate that Medicare or Medicare Advantage plans will ever cover assisted living or nursing home care. This means that Americans need to plan for long-term care costs while they are still working.
You can save money to private pay for this or you can look into applying for a long-term care insurance policy. If you are already past the point where you can medically qualify for LTC insurance, then you will typically spend down your assets until you can qualify for Medicaid.
Medicaid will pay for the costs of assisted living or nursing home care once a person has exhausted most of their assets and resources. Consult with a qualified estate planning or elder law attorney about the proper way to spend down so that you can qualify for Medicaid’s help with long-term care.
Common Questions Related to Medicare and Long Term Care
Here are some other common questions we receive that are related to whether Medicare and/or Medicare Advantage plans cover assisted living or nursing home care.
How much does Medicare cover for assisted living?
Medicare only covers the costs of qualified medical care that you receive while you are in assisted living. So just as before you entered the facility, your doctor visits, lab testing, and other inpatient and outpatient care are still covered.
However, Medicare does not pay anything toward the cost of the assisted living facility or nursing home itself, which can cost as much as $5000 – $8000/month.
Is there financial assistance for assisted living?
Yes, you can apply for assistance from Medicaid. There may also be laws in your state that allow for state-level assistance. Veterans can apply through the VA for assistance. There is an Aid and Attendance benefit program that some veterans may qualify for. If you own your home, you might also look into reverse mortgages to help fund the cost of assisted living.
Learn More About Medicare Advantage Plans
If you like the concept of Medicare Advantage plans and want to learn more, give our team a call today. We can help you search for plans in your area that have some of the supplemental home benefits discussed in this article.