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Does Medicare Pay for Home Care? …Senior Day Care? …Assisted Living?

What does Medicare Pay for? What good is Medicare anyways? Well, to most people’s surprise, it does NOT pay for long-term care such as non-skilled or non-medical home care, or senior day care nor does it pay for assisted living, memory care, or senior housing.  

Unfortunately, Medicare is intended to pay for short-term or temporary healthcare services. Therefore, if someone is in need of long-term care, I usually walk them through a series of qualifying questions, which I have included below. 

Outside of social security, pensions, stocks, bonds, and mutual funds, do any of these items apply to you: 

  1. Long-Term Care Insurance – Almost 10% of the population over 65 has a long-term care insurance policy. In most cases, this policy was purchased from the same individual who may have sold life, disability, or other insurance products.   Long-term care insurance is a great way to help pay for all or some of the costs of care. Policies may pay different rates (daily, weekly, monthly) depending on the type of care the individual chooses to receive.  
  2. Are you or your spouse a veteran? If you do not have long-term care insurance, then we’ll find out whether your loved one and/or their spouse is a veteran. If so, there is a chance that your loved one may qualify for the VA Aid & Attendance benefit.   This is a great benefit through the VA which may help cover some of the costs of home care, senior day care, or senior housing. This benefit ranges anywhere between ~$1,200 up to ~$2,200 depending on whether or not your loved one is the surviving spouse of a veteran or a married veteran.  
  3. Lastly, are you aware of the Statewide Medicaid Managed Care (SMMC) program? This is the question that I hate asking families who call because it means that they probably do not have long-term care insurance, nor do they qualify for the VA benefit. If someone is in need of care but is on a limited budget and does not have a lot of assets, then this is the best plan for them.   Individuals go through a qualifying process (financial and care assessment) and are added to the waitlist. If someone is in immediate need of care, has few financial resources, and cannot wait, then it is best for them to move into a skilled nursing facility, even if temporary until they get approved for Medicaid.  

If they still qualify for SMMC, then they will have the option to move out of the facility into an assisted living community that excepts SMMC. This will be done with case manager oversight through a Medicaid Managed Care Organization. 

If you are caring for your mom, dad, spouse, or a loved one, we are here to help! Receive a FREE copy of Florida’s 5 Step Guide to Senior Care by simply calling our senior care expert hotline at 941-676-3411 or visiting www.ActivAgeCare.com

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