With age comes concerns about maintaining independence and the ability to continue living at home. Due to chronic illness or injury, you may need assistance with everyday tasks. Physical decline may naturally occur with age, but many people also experience a mental decline that can threaten the safety of living alone. Others may need constant medical monitoring and care in addition to assistance with everyday tasks. Thankfully, there are a number of options available to residents of California and elsewhere when it comes to assisted living, but how this care is paid for can be complex and confusing.
Defining Assisted Living Care
Before discussing how assisted living gets paid for, it’s first important to define what assisted living care is. The term gets used to describe a range of scenarios, including living in a skilled nursing facility, having a nurse visit a private residence on a regular basis, or having a helper visit daily to assist with light housework.
Although all of these definitions are technically correct, in terms of Medicare coverage, assisted living coverage is based on whether care while staying in a facility is determined by a medical necessity. Care in a skilled nursing facility may be covered by Medicare Part A. Medicare will not help cover the cost of custodial care, which includes the activities of daily living, such as bathing, dressing, and preparing food.
Does Medicare Cover Assisted Living in California?
Original Medicare benefits in general provide coverage for assisted living in a skilled nursing facility under Part A. This is the same part of Medicare that covers expenses while admitted to a hospital. The skilled nursing facility coverage pays 100% of the cost and is limited to short-term stays of less than 21 days. After 20 days and up to 100 days, the patient may be responsible for a co-pay. After 100 days, Medicare does not provide coverage. California Medicare recipients are able to take advantage of assisted living benefits, but only in short durations when medically necessary. It should also be noted that these stays are based on a per-incident basis and may require a hospital stay prior to being admitted to a skilled nursing facility to qualify.
In California, the Medi-Cal program is the state’s version of Medicaid and will generally help pay for nursing home assisted living; however, this does not affect Medicare benefits recipients unless they are able to qualify for both programs. Medicare benefits do not pay for nursing home assisted living care. If you have a Medicare Advantage plan, you may be able to access certain assisted living benefits that are specific to your plan’s provider, so it would be a good idea to discuss your needs with your plan manager if you have questions.
Consider a Fee-for-Service Program
If you’re unable to afford the high cost of nursing home care on your own, you may want to talk to your doctor about the possibility of using a fee-for-service at-home assisted living care provider. These are private companies that hire nursing professionals who are able to make daily visits to patient homes to administer care. This option allows you to not only stay in your home, but also to have more direct control over your care choices and your finances. Once again, you will need to discuss this option with your physician as it may not be feasible for people facing certain medical conditions.
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