Financing a residency at a memory care center or assisted living facility can seem overwhelming at first.
If that’s the case for you, know that most residents and their families take a multi-faceted approach to finance long-term care for loved ones with Alzheimer’s or dementia. Many people ask if funding from Medicare or Medicaid is an option, but the answer can be complicated.
In the case of Medicare, these are some funding allotments are available intermittently, but only covering specific medical events or situations. For this reason, Medicare is not usually viewed as a consistent or foundational source of funding for Alzheimer’s or dementia care, which is also the case at The Memory Center communities.
If financing the cost of your preferred memory care center without Medicare or Medicaid is a factor for you, read our post, Affording Alzheimer’s Care, for more information.
How To Finance Memory Care & Assisted Living Without Medicaid or Medicare
Most individuals who transfer from home-based care into memory care or assisted living use a combination of financing sources. This includes financial support from:
- Retirement investments/savings
- Social Security or another pension(s)
- The sale of a home or property
- Taking a reverse mortgage out on a home
- Financial support from family members
- Long-term care insurance
- Private health insurance
- Medicare/Medicaid for specific or qualifying events
- Veteran’s benefits
When touring prospective communities or facilities, make sure to ask about monthly fees and exactly what they cover, learn more about their recommendations. If you are relying on Medicare/Medicaid coverage you will want to find out what, if anything, is covered in a community up front and also speak to your benefits coordinator.
When Are Medicare & Medicaid Are Viable Options For Qualifying Individuals?
In most cases, Medicare or Medicaid covers a portion of care costs for qualifying patients.
The term “qualifying” is the key here. Both programs are forms of federal assistance, but they differ in terms of benefits qualifications.
Seeking Financial Assistance From Medicare
Medicare is available to seniors 65-years and older OR individuals younger than 65-years who have qualified for Social Security benefits for at least 24-months prior.
In most cases pertaining to adults younger than 65, this comes by way of disability benefits.
If your loved one is showing signs or has been diagnosed with early onset dementia, speak to your doctor and schedule an appointment with your local Social Security Administration to learn more about what’s required to qualify for disability benefits. The combination of disability benefits and Medicare can considerably reduce your out-of-pocket care costs.
If you or your loved one are 65-years of age and you qualify to receive social security benefits, you are eligible for Medicare. You should have received ample notification to enroll in Medicare roughly three months before your 65th birthday. If not, enroll ASAP to avoid potential penalties.
All of the costs covered by Medicare can be applied to memory care centers or assisted living facilities who are willing to accept and work with Medicare billing. It’s important to note that in almost all cases, individuals have to be in the later stages of dementia or Alzheimer’s before Medicare coverage is available for anything other than medical appointments and treatments and not all communities work with Medicare benefits.
Typical Costs Covered by Medicare
Medicare is most likely to cover the following costs:
- Inpatient hospital fees, doctor’s visits, and some medical items for residents 65-years and older. If you have a Medicare Part D plan, prescriptions may also be covered.
- In limited circumstances, Medicare pays for up to 100 days of skilled nursing home care, following a hospital stay, although it does not cover long-term nursing home care.
- Hospice services, including when they take place at a nursing home or inpatient hospice center when patients are determined to have six months or less to live.
We recommend visiting Medicare’s webpage regarding Alzheimer’s coverage for more specific information about what is and isn’t covered. As this page so aptly puts it:
“Despite its shortcomings, Medicare, when used fully – and especially when augmented with Medicare Supplemental Insurance – can make a significant contribution towards the expense of caring for a loved with Alzheimer’s. Readers may want to explore this article which discusses other Medicaid and Veterans’ benefits for Alzheimer’s.”
Seeking Financial Assistance From Medicaid
Medicaid is jointly funded by both the federal government and the individual’s state of residence. It uses an asset/income-based qualification system that is quite strict in its qualification. Only those with very low asset/income levels or who have no financial resources are eligible for Medicaid.
In order to protect the system from abuse, there are extremely stringent laws preventing individuals from transferring property, assets or wealth to other family members ahead of time in order to qualify for assistance.
Those who legitimately qualify for Medicaid can expect all or a portion of their medical expenses to be covered, including nursing home or residential skilled nursing care.
However, be aware that not all nursing homes, assisted living facilities or memory care centers take Medicaid. In almost all cases, those who qualify for Medicaid must move or transfer to a state home- or community-based healthcare option to receive the benefits.
Early Planning Is Key To Securing Financing Before A Move Is Necessary
We can’t emphasize enough how much proactive research and planning ease the financial path toward memory care and assisted living.
By methodically going through the options, you’ll piece together a plan that works for your household budget. Giving yourself extra time means more opportunities to secure financing sources you may not think about or remember in knee-jerk crisis mode.
We also recommend utilizing local Alzheimer’s and dementia support groups, as well as online support groups and discussion forums. The individuals and facilitators in those groups have years of experience and wisdom behind them. You may learn about creative patch-working of financing opportunities you wouldn’t hear or read about otherwise.
And, of course, the staff at your prospective memory care centers or assisted living facilities should be informative on the topic of Medicare/Medicaid financing as well. Their willingness to walk you through some basics, sharing their information and advice, can be viewed as part of the interview process and shed light into the heart and soul of the center’s administration and staff.
Learn more about selecting and financing memory care in these related articles: