Does Medicare Pay for Assisted Living in Maryland?

While Original Medicare covers many healthcare needs, it does not pay for long-term custodial care in assisted living facilities. This crucial distinction means Maryland residents must understand exactly what is and isn't covered when asking, does Medicare pay for assisted living in Maryland?

Quick Summary

Original Medicare does not cover the long-term, non-medical expenses of assisted living in Maryland, such as room and board. Maryland residents must investigate other payment methods, like Medicaid waivers and state-specific programs, to cover these costs.

Key Points

• Medicare Does Not Cover Custodial Care: Original Medicare, including Medicare Advantage plans, does not pay for the long-term, non-medical support provided in assisted living facilities.

• Maryland Medicaid Offers Waivers: For low-income residents, the Maryland Medicaid Community Options Waiver may cover personal care services within an assisted living facility, though it doesn't cover room and board.

• SALS Program Provides Subsidies: The Senior Assisted Living Subsidy (SALS) Program is a state-funded program in Maryland that offers financial assistance for assisted living to eligible seniors.

• Alternative Funding is Necessary: Families in Maryland must rely on other resources like long-term care insurance, personal savings, or VA benefits to cover assisted living expenses.

• Consult Maryland Access Point: The best starting point for information on Maryland-specific financial assistance and resources is a local Maryland Access Point (MAP) agency.

• Proactive Planning is Crucial: Since Medicare won't cover long-term care, understanding and exploring alternative payment options well in advance is essential for securing senior care.

Understanding Medicare's Coverage Limitations

Original Medicare (Parts A and B) is designed to cover medically necessary care, not the long-term custodial care that assisted living facilities provide. Custodial care includes non-medical assistance with daily activities like bathing, dressing, and eating. This is the fundamental reason why Medicare typically does not cover the cost of staying in an assisted living community. It's a common misconception that many families face when planning for a loved one's senior care.

While Medicare will not pay for the room and board expenses, it will continue to cover approved healthcare services even if you are living in an assisted living facility. This includes:

• Doctor visits and other outpatient care (Medicare Part B)
• Prescription medications (Medicare Part D)
• Hospital stays and related services (Medicare Part A)
• Medical equipment, such as walkers or wheelchairs

When Medicare Might Cover Care in a Long-Term Setting

There are specific, short-term situations where Medicare may cover services in a nursing or skilled care setting, but these are distinct from assisted living. For example, Medicare Part A can cover a short-term stay in a Skilled Nursing Facility (SNF) following a qualifying inpatient hospital stay. This is for skilled care and rehabilitation, not ongoing custodial support.

Assisted Living Costs in Maryland and Alternative Funding

Since Medicare is not an option for long-term assisted living costs in Maryland, families must consider other avenues. The cost of assisted living in Maryland can vary significantly based on location, facility size, and level of care. Fortunately, Maryland residents have several options to explore.

Maryland Medicaid and Waiver Programs

Medicaid is a joint federal and state program that can provide financial assistance for long-term care for low-income individuals. Unlike Medicare, some Medicaid programs can help cover assisted living costs. In Maryland, the primary vehicle for this is the Home- and Community-Based Options Waiver, also known as the Community Options Waiver.

This waiver program helps cover personal care and other supportive services provided within an assisted living setting, though it does not cover the room and board portion. Eligibility for the waiver depends on meeting specific medical and financial criteria. For example, a person must be functionally impaired and require a certain level of care.

Maryland Senior Assisted Living Subsidy (SALS) Program

For low-to-moderate-income seniors who need help affording assisted living but may not meet the strict financial criteria for Medicaid, Maryland offers the Senior Assisted Living Subsidy (SALS) Program.

• Who it helps: Adults age 62 and older with limited financial resources.
• What it covers: The subsidy can help defray the cost of care services in a licensed assisted living facility that participates in the program.
• How to apply: Interested individuals should contact their local Maryland Access Point (MAP) agency for information and to start the application process.

Long-Term Care Insurance

Private long-term care insurance policies can be an excellent way to cover assisted living expenses. These policies are purchased well in advance and can cover services like personal care and supervision in a variety of settings, including assisted living facilities. However, eligibility and premiums depend on age and health status at the time of application, and benefits only begin after a specified waiting period.

Veterans Benefits

Some veterans and their surviving spouses may be eligible for financial assistance through the Department of Veterans Affairs (VA) Aid and Attendance pension. This benefit is available for veterans who require the aid of another person for daily activities. The funds can help pay for care in an assisted living facility. Eligibility is based on service, income, and asset requirements.

Personal Funds and Other Resources

Many residents rely on personal savings, investments, or the sale of a home to cover assisted living expenses. Other options include reverse mortgages or cashing out life insurance policies.

Comparison: Medicare vs. Maryland Medicaid for Assisted Living

To clarify the differences, here is a comparison of how Medicare and Maryland's Medicaid waiver relate to assisted living coverage.

Feature	Original Medicare	Maryland Medicaid Waiver (Community Options)
Coverage	No coverage for long-term custodial care (room and board) in assisted living. Covers medically necessary healthcare services only.	Covers personal care and supportive services within an approved assisted living facility. Does not cover room and board.
Eligibility	Age 65+ or certain disabilities. Not needs-based for assisted living services.	Must meet medical criteria (functional impairment) and specific income and asset limits.
Purpose	Acute medical care, short-term skilled nursing, home health, hospice.	Long-term services and supports for those who would otherwise need a nursing home level of care.
Application	Enrollment in Medicare is standard for eligible individuals.	Requires an application and assessment process through a local Maryland Access Point.

How to Plan for Assisted Living in Maryland

1. Assess Your Needs: Before exploring financial options, determine the level of care and type of facility needed. Contact a local Maryland Access Point for pre-placement counseling.
2. Explore State Programs: Investigate whether you or your loved one might qualify for the Maryland Community Options Waiver or the Senior Assisted Living Subsidy Program. Visit the Maryland Department of Aging for detailed program information.
3. Evaluate Other Financial Options: Consider long-term care insurance, VA benefits, or personal assets as potential payment sources.
4. Seek Professional Advice: Consult with a financial planner or elder law attorney who can help navigate the complexities of paying for long-term care in Maryland.

Conclusion: Proactive Planning is Key

For anyone considering assisted living in Maryland, understanding that Medicare does not cover the bulk of these costs is the first and most important step. Relying on Medicare for long-term residential care is not a viable strategy. Instead, by proactively exploring Maryland-specific programs like the Medicaid waiver and SALS, along with other funding sources, you can build a comprehensive financial plan. This approach ensures you are prepared to meet the needs of your or a loved one's senior care journey with confidence.

Frequently Asked Questions

What is the difference between Medicare and Medicaid for assisted living in Maryland?

The main difference is that Medicare does not pay for long-term assisted living, but certain Maryland Medicaid programs, like the Community Options Waiver, can cover personal care services within an assisted living facility for those who qualify financially and medically.

Does the Maryland Senior Assisted Living Subsidy (SALS) program cover room and board?

The SALS program provides a subsidy to help defray the costs of care services, personal care, and supervision in a licensed assisted living facility for eligible seniors, but may not cover the full cost of room and board.

Can I use a Medicare Advantage plan to pay for assisted living in Maryland?

Medicare Advantage plans, also known as Part C, must cover everything Original Medicare does, but like Original Medicare, they do not cover long-term assisted living costs. Some may offer limited extra benefits, but room and board is not typically covered.

Are there income and asset limits for Maryland Medicaid assisted living waivers?

Yes, there are specific income and asset limits to qualify for Medicaid in Maryland. For a single senior, the income limit is typically around the federal benefit level, and there's a low asset limit. Consulting a Medicaid planning expert is recommended.

How can veterans' benefits help pay for assisted living in Maryland?

Eligible veterans and their surviving spouses in Maryland may be able to receive financial assistance through the VA's Aid and Attendance benefit. This is a pension that can help cover assisted living costs for those who need daily assistance.

Does long-term care insurance cover assisted living in Maryland?

Yes, many private long-term care insurance policies are designed to cover assisted living expenses. Coverage typically applies once a policyholder needs help with at least two 'Activities of Daily Living' (ADLs), such as bathing and dressing.

Where can I get help planning for assisted living costs in Maryland?

You can start by contacting a Maryland Access Point (MAP) agency for counseling and to learn about local resources and programs. You can also consult an elder law attorney or a financial planner specializing in senior care.