Understanding Medicare and Assisted Living Coverage
Medicare, the federal health insurance program for people 65 or older, is designed to cover medically necessary services, not long-term custodial care like that provided in assisted living [1]. Custodial care includes assistance with daily activities such as bathing, dressing, and eating [1].
Original Medicare: Parts A and B
Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance) [1]. Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Part B covers doctor services, outpatient care, medical supplies, and preventive services [1]. Assisted living costs, including room, board, and personal care, are not covered by Original Medicare because they are considered custodial care [1].
The Nuances of Skilled Nursing vs. Custodial Care
Medicare Part A may cover a short-term stay in a skilled nursing facility (SNF) under specific conditions, often following a hospital stay for medically necessary care like physical therapy [1]. Assisted living, however, focuses on long-term support for daily activities, which is custodial care and not covered by Medicare [1].
Medicare Advantage Plans and Assisted Living
Medicare Advantage Plans (Part C), offered by private companies, must cover all services included in Original Medicare but typically do not cover comprehensive assisted living costs like room and board [1]. Some plans might offer limited non-medical benefits, but this varies by plan [1]. While in assisted living, Medicare (Original or Advantage) will still cover approved medical services like doctor visits [1].
Maryland-Specific Assisted Living Financial Assistance
Maryland provides state-specific programs to assist residents with assisted living costs since Medicare does not cover these expenses [2].
Maryland Medicaid Waiver Programs
Maryland's Medicaid program offers waiver programs that can help cover supportive services in assisted living facilities, allowing individuals to receive long-term care in community settings [2]. These programs may cover services such as personal care and case management, though not room and board [2].
Senior Assisted Living Subsidy (SALS) Program
The Senior Assisted Living Subsidy (SALS) program is a state-funded, non-Medicaid program for eligible low-income seniors in licensed assisted living facilities [2]. It provides a subsidy to help with assisted living expenses, with eligibility based on income and assets [2].
Comparison of Funding Options for Assisted Living in Maryland
| Feature | Medicare | Maryland Medicaid Waiver | Senior Assisted Living Subsidy (SALS) |
|---|---|---|---|
| Coverage | Limited medical services only; no room/board [1]. | Supportive services (personal care, case management) [2]. | Direct subsidy for assisted living expenses [2]. |
| Eligibility | Age 65+ or with certain disabilities [1]. | Low income and asset limits; functional needs assessment [2]. | Low income and asset limits; residency in licensed facility [2]. |
| Application | Automatic for Social Security recipients [1]. | Via the Maryland Department of Health or local Area Agency on Aging [2]. | Via the Maryland Department of Aging or local Area Agency on Aging [2]. |
| Exclusions | Most long-term custodial care [1]. | Room and board portion of costs [2]. | Income and asset requirements must be met [2]. |
| Primary Function | Acute and skilled medical care [1]. | Funding community-based long-term care [2]. | Supplementing costs for low-income seniors [2]. |
Other Avenues for Funding Assisted Living
Additional strategies can help fund assisted living costs:
- Long-Term Care Insurance: Private policies can cover assisted living expenses, with coverage and costs varying by policy [3].
- Veterans' Benefits: The Aid and Attendance pension benefit may provide financial assistance to qualifying veterans and their spouses for assisted living [4].
- Personal Savings and Assets: Using personal funds, investments, or selling assets like a home are common methods [3].
- Life Insurance: Some policies offer accelerated death benefits or cash value that can be used for care [3].
How to Plan for Assisted Living Costs in Maryland
Effective planning is crucial:
- Assess Needs and Resources: Evaluate care needs and financial resources, including savings and potential income [3].
- Explore Maryland State Programs: Contact your local Area Agency on Aging for information on programs like Medicaid waivers or SALS [2].
- Investigate Veterans' Benefits: If applicable, explore VA benefits like Aid and Attendance on the U.S. Department of Veterans Affairs website [4].
- Consider Long-Term Care Insurance: Research private policies if planning in advance [3].
- Create a Financial Plan: Work with a financial planner specializing in senior care to develop a comprehensive strategy [3].
Conclusion: The Bottom Line on Medicare and Assisted Living
Medicare does not cover the long-term custodial care costs of assisted living in Maryland [1]. Its coverage is for specific medical needs [1]. However, Maryland residents have options, including state Medicaid waivers and the Senior Assisted Living Subsidy program [2], as well as veterans' benefits and private insurance [3, 4]. Proactive planning and research are essential for navigating these costs.
