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Does Medicare Pay For Nursing Home For Alzheimer’s

What Is Custodial Care

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In the eyes of the Centers for Medicare and Medicaid Services , custodial care is care that does not have to be performed by a skilled or licensed medical professional such as a doctor, nurse, or therapist . Custodial care often includes assistance with bathing, cleaning, cooking, dressing, hygiene, and even walking or mobilizing.

Unfortunately, many seniors in nursing homes are there for reasons of safety. They are unable to live independently due to dementia or other medical conditions, and they may not have family or loved ones who can support them.

According to the February 2019 Vital Health Statistics report by the U.S. Department of Health and Human Services , the majority of people in nursing homes require custodial care. The percentages of people needing help are considerable:

  • Bathing: 96.7%
  • Transferring In or Out of Bed: 86.8%
  • Walking: 92%

Medicare Part A Coinsurance

If you experience an inpatient hospital stay related to your dementia care, you will typically be responsible for the following coinsurance costs after meeting your deductible:

  • Days 1-60spent in the hospital: $0 coinsurance for each benefit period
  • Days 61-90: $389 coinsurance per day of each benefit period in 2022
  • Days 91 and beyond: $778 coinsurance per each lifetime reserve day after day 90 for each benefit period in 2022
  • Beyond lifetime reserve days: you pay all costs

You cannot accrue any additional lifetime reserve days.

If you are admitted to a skilled nursing facility for care, you will be responsible for the following coinsurance costs:

  • Days 1-20: $0 coinsurance for each benefit period
  • Days 21-100: $194.50 coinsurance per day of each benefit period in 2022
  • Days 101 and beyond: you pay all costs

Using Private Insurance To Cover Nursing Home Care

Many Americans use long-term care insurance to cover nursing home fees and other personal care costs in their elder years. Long-term care insurance is designed to lower out-of-pocket expenses for stays in a broad range of care settings, including nursing homes and assisted living facilities. Its best to buy a long-term care insurance policy well before the need to use it is likely to arise, even if this means paying premiums for many years. Premium rates are much lower for people who are in good health when they purchase their policy.

If your loved one has a life insurance policy, cashing it out can help him or her pay for nursing home costs, and certain types of life insurance will allow the policyholder to use it as long-term care insurance. If a life insurance policy includes accelerated death benefits, policyholders are able to take a portion of their death benefit while theyre still alive in order to pay for long-term care. In cases where the death benefit is not enough to cover nursing home costs, the policyholder might choose a life settlement, in which he or she sells the life insurance policy to a third party.

Today, there are also a number of combination life insurance policies that include long-term care benefits, although these policies tend to be pricier than standard life insurance.

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Senior Life Insurance Policies

Some senior life insurance policies can be exchanged for Alzheimers care. Certain life insurance policies may be sold for a lump sum, which allows you to receive monthly payments. Some life insurance policies can also be converted into months or years at a residential care facility.

If you have a policy that builds cash value inside it, which basically means that it has a savings account inside of it, then an individual may be able to do a couple of different things to use those resources for long-term care, says Ash.

If you decide you no longer want the death benefit, you could cash out, or cancel, the policy and use the money to pay for memory care. Another option may be to take out a policy loan, says Ash. You use some money to pay for long-term care, but if its not all used, the rest remains a death benefit for beneficiaries. Be sure to talk with the insurance company or their agent about possible impacts to the policy, so you make an informed decision about whether or not this is a good idea for you.

A life insurance, long-term care hybrid policy is becoming more and more popular, says Ash. Many people have bought policies that have a death benefit as well as long-term care features.

If you have a life insurance policy and need ways to pay for memory care, check on the specific details with your insurance company. Many have special provisions that may help you afford memory care.

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Although memory care is commonly financed through savings, there are several additional funding sources that many people dont know about. There are also many professionals who can provide clarity on this complex and naturally emotional topic.

When parents need long-term care, especially if its sudden, it can be very overwhelming, says Michelle Ash, a certified financial planner in Jacksonville, Florida, and Chartered Advisor for Senior Living. Try to stop, take a breath, and make a list of financial sources that can help you access some short-term immediate funds while you get your head around the bigger financial picture.

From veterans benefits to home equity to life insurance policies and more, learn how to pay for memory care and how to find financial guidance or resources to reduce stress along the way.

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How Do I Find The Right Nursing Home

It takes time to research nursing homes and decide on the one thatâs best for your loved one. So you should start looking long before youâll need to take the step of moving them. Many facilities often have waiting periods, too. Plan ahead so you can make the transition much easier.

Family and caregivers should talk about what services their loved one needs and how often they need them. Think about whatâs important to you before you start calling different nursing homes.

Before you schedule visits to the ones youâre interested in, ask about vacancies, admission requirements, the level of care they provide, and if they accept payment with Medicare, Medicaid, or other government-funded health insurance options.

Does Medicare Cover Memory Care In 2022

Medicare can cover some parts of memory care, such as inpatient stays, doctor visits, home health care, and diagnostic tests, but it wont cover long-term care, assisted living, or other services that assist with personal care or activities of daily living.

Medicaid and Medigap, however, can each be used to cover what Medicare wont.

FYI: To learn more about memory care, check out our guide: What Is Memory Care?

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Paying For Nursing Home Costs

If you depend on your Social Security to pay for assisted living, it’s not enough.

The average benefit received in the form of a Social Security check for a retired worker is $1,230, and for a couple, it is $2,045. Both are short of the cost of assisted living. And if one spouse requires care in a nursing home facility, and the other remains home, it’s certain the benefit will not cover living expenses for both.

Hardly enough when the is over $6,000 per month, depending on where you live.

As seniors and families begin to look at the monetary assets available, they find themselves plunged into unfamiliar territory.

Another source of supplemental income from the federal government is , Supplemental Security Income . A senior must be at least 65 years of age to apply. It’s a needs-based program that provides a monthly check to persons who are blind, elderly, or disabled. SSI is only available to persons with a very low-income and asset limits.

The average SSI for an individual is a little over $700/month and for a couple it is over $1000/month. To learn if you are eligible to apply: Check out the Social Security disability program.

If you’re 65 or over and receive Supplemental Security Income, you may apply for Medicaid that can assist you in paying for nursing home care. It is a federally funded program for low-income Americans and the biggest payer for the room, board, nursing care, and social activities in nursing homes.

Nursing Home Costs And Ways To Pay

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The cost of nursing home care in the U.S is prohibitive for many, and it can vary widely between regions and states, from around $5,000 per month up to a surreal $25,000 per month. How much a nursing home charges depends on its geographic location, staffing levels, the complexity of care offered and the facilitys size and quality. Additionally, there may be à la carte costs to contend with. For example, a facility that offers social services like financial management aid is likely to charge extra for that feature, among others.

Nursing home prices can make it tempting to look for less costly, less supportive residential care options such as assisted living. However, nursing homes should never be conflated with assisted living facilities. Knowing the difference between the two is an important part of making sure you or someone you are responsible for is getting a sufficient level of aid and supervision.

While assisted living offers minor assistance with personal care as well as social and health-related community functions, what makes a nursing home different from other elder care choices is that residents are under the 24-hour supervision of licensed or registered nursing staff or of certified nursing assistants .

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How To Pay For Dementia Care

With all these numbers and often, unfathomable numbers dancing around in your head, its easy to panic. How will your loved one ever be able to afford dementia care over the next one, three, five or more years?

You can breathe a sigh of relief because, thankfully, government assistance, private aid, and other help exists to help you pay for the skilled care your loved one needs.

Heres a basic overview:

Medicare

Like most health insurance, Medicare makes no differentiation between dementia care and other diseases, such as cancer. What this means in practical terms is that, if your loved one qualifies for Medicare, then Medicare will pay for dementia care within very firm limits and theyre strict, often frustrating limits: 100% of nursing home care for 20 days, and 80% of nursing home care for up to an additional 80 days. Thats just 100 days, or less than 3 months of nursing home care.

Additionally, Medicare will not cover custodial or personal care, in-home health aides, or even assisted living for dementia patients. For this reason, dementia patients almost always require secondary assistance, beyond the confines of Medicare. Which brings us to:

Medigap and Supplementary Insurance

Medigap care does not specifically cover dementia care, but it typically does pay the final 20% of nursing home care that Medicare does not cover.

Veteran Assistance

Medicaid

For dementia patients who require highly skilled care, Medicaid is the largest single payer of nursing home care.

Your Nursing Home Costs In :

  • Medicare generally pays 100% of the first 20 days of a covered nursing home stay.
  • Days 21 to 100: $185.50 coinsurance per day of each benefit period. You pay coinsurance for each day of the benefit period.
  • If you stay in a skilled nursing facility longer than 100 days per benefit period, Medicare typically stops paying nursing home costs.

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Medicare Advantage Plans May Offer More Benefits For Dementia Care

As part of the Chronic Care Act of 2018, Medicare Advantage plan providers are able to provide expanded benefits to their beneficiaries, called supplemental benefits, starting in 2019 and 2020.

Some of these additional benefits may include:

  • Home modifications, such as bathroom grab bars
  • Non-medical home care, such as custodial care
  • Adult day care

Because Medicare Advantage plans are sold by private insurance companies, plan availability and the benefits they offer may vary from one location to another.

To learn more about Medicare Advantage plans in your area, your eligibility to enroll, and the benefits that they offer, call to speak with a licensed insurance agent today.

Compare Medicare Advantage plans in your area

Or call 1-800-557-6059TTY Users: 711 24/7 to speak with a licensed insurance agent.

Other Nursing Home Coverage

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If you qualify, due to medical necessity, you may have other options available to you for Medicare coverage of nursing home care:

  • Some Medigap plans help pay for nursing homes. If the care and services you get are covered by Medicare, usually there are still at least some costs to you. If you have a Medigap plan, it might pay for some of those costs.
  • Certain nursing homes have contracts with Medicare plans, such as Medicare Advantage plans . In such cases, the plan might help pay for the nursing home care. If you have a Medicare Advantage plan or a Medicare Supplement insurance plan, ask your plan provider about their nursing home coverage.
  • If you have a Medicare Part D Prescription Drug Plan, it covers drugs that skilled nursing staff gives you.
  • If youâre enrolled in both Medicare and Medicaid, Medicare enrolls you into a Medicare Part D Prescription Drug Plan automatically.
  • If youâre not eligible for Medicaid, you might have to pay for some or all of your drug costs.
  • Some employer group health plans and long-term care insurance help cover the costs of nursing homes.
  • If youâre eligible for Medicaid, it might pay most of your nursing home costs. Your stateâs State Health Insurance Counseling and Assistance Program program can tell you if you qualify. You can call 1-800-MEDICARE and ask a Medicare Ombudsman about the SHIP program.
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    Whos Eligible For Medicaid Nursing Home Coverage

    Medicaid nursing home coverage is available only to people who are unable to care for themselves at home. They must meet their states eligibility limits regarding income and assets, which differ depending on whether the resident is single or part of a married couple . They may reside in any level nursing home thats certified by Medicaid and that accepts Medicaid payment. Be aware, however, that some nursing homes only accept Medicaid payment for a limited number of residents.

    Unlike Medicare coverage of nursing home care, theres no Medicaid requirement of a prior hospital stay, no restriction to skilled nursing facilities, and no requirement that the person need skilled nursing home care or still be recovering from an illness or injury in order for Medicaid to continue coverage. In other words, Medicaid unlike Medicare will cover residence in a nursing home purely to provide help with the nonmedical activities of daily living whats called custodial care.

    Where Can I Find Medicaid And Medicare Memory Care Services Near Me

    • Medicaid recipients: Contact your State Medicaid Agency.
    • Medicare recipients: Call 1-800-MEDICARE . TTY users call 877-486-2048.

    From the experts: Dr. Abby Altman, a geropsychologist and senior mental health expert, walks you through all of the considerations for choosing a memory care facility.

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    Types Of Nursing Home Costs Medicaid Covers

    For eligible beneficiaries, Medicaid pays the full cost of room and board in a nursing facility, plus any therapies that are part of the nursing homes regular resident care. Medicaids payment also includes personal care items such as incontinence supplies and toiletries, as well as services such as bathing, grooming, and laundry.

    Theres no time limit on Medicaid nursing home coverage, and the Medicaid beneficiary has no co-payments to make.

    The income limits for Medicaid nursing home coverage eligibility are different for an unmarried, divorced or widowed person than for a married couple.

    How Can I Pay For Nursing Home Care

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    Medicare generally doesn’t cover

    stays in a nursing home. Even if Medicare doesnt cover your nursing home care, youll still need Medicare for hospital care, doctor services, and medical supplies while youre in the nursing home. Find out what nursing home care Medicare does cover, and how Medicare prescription drug coverage works if you live in a nursing home or other institution.

    Most people who enter nursing homes start by paying for their care out-of-pocket.

    There are several other ways you can pay for nursing home care:

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    Options To Help Pay For Alzheimers Care

    Original Medicare pays for some costs associated with Alzheimers disease, but there are also some insurance options that could help with care-related expenses.

    • Some Medicare Advantage plans often offer coverage that Original Medicare does not, such as home health services, transportation to and from doctor appointments, and adaptations to your home. But not all extra benefits are available with all Medicare Advantage plans.
    • Long-term care and disability supplemental insurance plans can also help with Alzheimers costs, depending on the plan. You must be enrolled in one of these supplemental plans prior to a diagnosis.16
    • Some life insurance policies will allow you to borrow a policys cash value or offer accelerated death benefits.16

    Talk with a licensed health insurance agent about which options would work best for you and your familys needs.

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