A Place for Mom's Business Model
A Place for Mom operates as a referral service that helps families find suitable senior living options, such as assisted living, memory care, and in-home care. Their business model is funded by the care providers and communities themselves, not by the families using their service. When a family is successfully placed in a partner community, that community pays a referral fee to A Place for Mom. This means the service remains free for families, but it is important to understand that Medicare is not involved in any part of this payment structure.
Why Medicare Does Not Cover Referral Services
Medicare is a federal health insurance program for seniors and certain younger people with disabilities. Its primary purpose is to cover medical and healthcare-related expenses. It is not designed to cover non-medical services like:
- General guidance or concierge services.
- Placement assistance to find housing.
- Brokering relationships with senior living communities.
These activities fall outside the scope of what Medicare is authorized to pay for. The program's coverage is strictly defined and focused on medical necessity, not on locating residential facilities or negotiating contracts with them.
Medicare's Coverage vs. Non-Coverage for Senior Care
To fully grasp why Medicare doesn't pay for A Place for Mom, you need to understand the fundamental difference between medical care (covered) and custodial care (generally not covered).
What Medicare Covers
Medicare Part A (Hospital Insurance) covers short-term, medically necessary stays in a skilled nursing facility (SNF) following a qualifying hospital stay. This coverage is limited to 100 days per benefit period and does not extend to permanent, long-term stays.
Medicare Part B (Medical Insurance) covers outpatient medical services, including doctor visits, lab tests, and durable medical equipment. If a person is living in a senior community, Medicare will cover these medical services, but it will not pay for the room and board or custodial care required within that facility.
What Medicare Doesn't Cover
- Custodial Care: This is the primary type of care received in most assisted living communities. It includes assistance with daily living activities (ADLs) such as bathing, dressing, eating, and using the bathroom. Medicare does not cover this type of non-skilled, long-term care.
- Room and Board: The cost of housing and meals within a senior living community is not covered by Medicare, regardless of the level of care required.
- Long-Term Care: Unlike short-term skilled nursing, long-term, ongoing care is not a Medicare benefit. This applies to assisted living, memory care, and long-term nursing home stays.
Comparing Payment Options for Senior Living
Understanding the various ways to pay for senior living is crucial for families. The following table compares common funding sources for senior care.
| Funding Source | Covers Medical Costs? | Covers Custodial Care? | Covers Room & Board? | Key Considerations |
|---|---|---|---|---|
| Medicare | Yes | No | No | Strictly for medically necessary services; not for long-term residency. |
| Medicaid | Yes | Yes (often via waivers) | Yes (often via waivers) | State-specific program for low-income individuals; eligibility is strict and varies. |
| Private Pay | No | Yes | Yes | Uses personal savings, retirement funds, or proceeds from selling assets like a home. |
| Long-Term Care Insurance | Depends on policy | Yes | Yes | Private insurance that covers long-term custodial care; coverage details vary widely by plan. |
| Veterans' Benefits | Depends on program | Yes | Yes | Aid & Attendance benefits can help eligible veterans and surviving spouses pay for care. |
Exploring Alternatives for Senior Care Financing
Since Medicare doesn't pay for A Place for Mom or the long-term care facilities they recommend, exploring other funding options is essential.
- Medicaid: Many states offer Medicaid waiver programs that help cover some of the costs associated with assisted living and home care for low-income seniors. Eligibility requirements for these waivers are stringent and vary significantly by state. It is wise to research your state's specific rules.
- Long-Term Care Insurance: Private long-term care insurance policies are designed specifically to cover services like custodial care and room and board. If a senior has such a policy, it can be a valuable resource for covering assisted living expenses.
- Veterans' Benefits: Eligible veterans and their surviving spouses may qualify for the Aid and Attendance benefit, which can provide financial assistance to help pay for assisted living or home care.
- Private Funds: Most seniors initially pay for assisted living and other long-term care out of pocket. This can include using retirement savings, selling assets, or receiving financial assistance from family members.
- Reverse Mortgage or Home Equity: For seniors who own a home, a reverse mortgage or a home equity line of credit can be a way to access funds to pay for care. It is important to weigh the pros and cons of these options carefully.
For more detailed, authoritative information on Medicare's coverage limitations, the official government source is the best place to start. A good place to begin your research is the Medicare.gov website which clarifies what is and isn't covered in terms of long-term care.
Conclusion
It is a persistent myth that Medicare will pay for all or even most of a senior's long-term care. In reality, the federal program is designed for medical services, leaving the financial burden of custodial care and housing on families. While A Place for Mom is a useful, free-to-families referral service, it is not a benefit covered by Medicare. Families must research alternative funding methods, such as private pay, Medicaid waivers, or long-term care insurance, to finance senior living and other non-medical care needs.
