Do Medicare Advantage Plans Cover Assisted Living?

Medicare beneficiaries can choose whether to continue coverage under Original Medicare or move to a Medicare Advantage plan. While Medicare Advantage plans include the services provided by Medicare Parts A and B, they often go a step further by tossing in extra benefits not covered by Original Medicare.

It's important to note that Medicare Advantage plans generally do not extend coverage to assisted living expenses. However, there have been helpful changes. Some Medicare Advantage plans now feature benefits associated with long-term services, such as in-home patient support, home safety modifications, and adult day care services.

This coverage shift happened in 2018 when legislation enabled Medicare Advantage plans to introduce supplementary home services designed to assist individuals dealing with chronic illnesses. Today, we want to explore how both Original Medicare and Medicare Advantage plans help with assisted living expenses.

Original Medicare and Long-Term Care

Under Original Medicare, inpatient care falls under Part A benefits. This includes acute hospital care, skilled nursing care, and hospice benefits.

Following a qualifying inpatient hospital stay, Part A covers the expenses for a stay in a skilled nursing facility (SNF), albeit on a short-term basis. This coverage is limited to 100 days, and beyond that, the costs become your responsibility.

The primary objective of SNF care is to aid in recovery and rehabilitation following a medical injury, illness, or procedure. It is well-suited for individuals recuperating from conditions like joint replacements or strokes. However, it is not designed to cater to those who are unlikely to recover fully.

For instance, if a person has dementia and is not expected to regain the ability to live independently, they would transition to long-term care, necessitating personal financial responsibility.

Medicare Advantage Plans and Long-Term Care

Medicare Advantage plans, like Original Medicare, have coverage for up to 100 days in a skilled nursing facility. However, Medicare Advantage plans distinguish themselves by incorporating additional perks, such as routine dental and vision care.

In recent years, these plans have added flexibility by including supplemental home care benefits. While these benefits may not equate to full-time assisted living or nursing home care, they serve to assist beneficiaries in maintaining independence within their homes for an extended duration before considering a transition to full-time assisted living.

It's essential to recognize that the inclusion of these benefits is subject to the discretion of each Medicare Advantage insurance company. Consequently, the availability of supplemental home care benefits varies, with some plans opting to offer them while others do not.

The following are some of the non-medical, supplemental home health-related benefits you may begin to see in some Medicare Advantage plans.

Home Safety Modifications

Individuals often consider transitioning to assisted living after experiencing a fall or other challenges in navigating their homes. Because of this, Medicare Advantage plans have introduced the option to provide valuable home safety modifications. These include the installation of wheelchair ramps, bathroom safety grab bars, and specialized air conditioners tailored for people with respiratory conditions.

The underlying objective is to make these home improvements more accessible, enabling more people to afford and implement them. The goal is that by facilitating such modifications, medical emergencies may decrease, which would allow elderly individuals to prolong their ability to live independently at home before the necessity for assisted living arises.

Personal Care Services in Your Home

The decision to transition to long-term care often comes up when individuals find themselves unable to manage their activities of daily living (ADLs), including tasks such as bathing, dressing, basic hygiene, and preparing/eating their own meals. To address these challenges, Medicare Advantage plans now have the benefits to provide valuable assistance through in-home support services, available for a specified duration each week or month.

By offering home health aides to assist beneficiaries with essential tasks, including cooking and cleaning, insurance carriers aim to potentially reduce expenditures on medical treatments. This proactive approach not only enhances the quality of life for beneficiaries but also contributes to managing healthcare costs more effectively.

Nutrition and Transportation Support

For certain Medicare beneficiaries who find themselves unable to drive and lack access to affordable transportation alternatives, maintaining independent living becomes even harder. To help, some Advantage plans are now equipped to extend limited transportation services. These services assist individuals in getting to medical appointments and prescriptions from the pharmacy. Additionally, plans may offer the convenient delivery of hot meals directly to the member’s home.

It's important to note that the frequency and details of these services can vary among different plans. Prospective enrollees should carefully review the specific provisions of each plan to ensure they align with their individual needs and preferences.

Adult Day Care

Over the past decade, Adult Day Care services have gained significant popularity, serving as a valuable resource for full-time caregivers who need a break or time to attend to other responsibilities. These services ensure that members receive proper care in a secure environment, allowing caregivers the opportunity for respite.

Often operating five days a week, some centers may extend their services to weekends. Adult Day Care centers emphasize social interaction, offering participants the chance to engage in activities such as crafts, exercise, games, and music therapy. Centers may specialize in medical care and/or memory care for their patients.

In light of recent legislation, there is anticipation that some Medicare Advantage plans may integrate adult daycare services into their plan offerings. Even if an Advantage plan provides only a few days per month of adult day care, it could significantly alleviate the burden on caregivers, offering much-needed support.

Over the Counter Stipends

Medicare Advantage plans, despite typically covering Part D medications, are now expanding their offerings to include over-the-counter medications. This enhancement involves the introduction of monthly or quarterly stipends that members can utilize to purchase a range of items such as vitamins, pain relievers, allergy medicines, and other over-the-counter products.

Typically presented in a catalog format, members will receive a catalog detailing available items, and they will have a predetermined allowance to spend on these over-the-counter products. This initiative aims to provide beneficiaries with added flexibility and support in managing their healthcare needs, encompassing both prescription and non-prescription medications.

Telehealth Services

Many Advantage plans are introducing a valuable addition – telehealth services. These innovative services empower members to consult with their doctors through video calls on their smartphones. This proactive approach not only enhances accessibility to healthcare but also accommodates the unique needs of individuals who may find traditional in-person visits challenging. The integration of telehealth services signifies a commitment to providing convenient and efficient healthcare options for Advantage 

Do All Medicare Advantage Plans Offer These Benefits?

No, not all Medicare Advantage plans will offer the same benefits. With thousands of Medicare Advantage plans available across the country, the inclusion of specific benefits can vary widely among them. If supplemental home benefits, or any other specific benefits, are important to you, it's crucial to conduct thorough research on the plans available in your area.

To determine the extent of support benefits offered by a particular plan, it's advisable to review the plan's Summary of Benefits. This document provides detailed information about the coverage and services included in the plan design. By carefully examining the Summary of Benefits for each plan, you can make an informed decision based on your individual healthcare needs and preferences.

Learn About Medicare Advantage Plans

If you're interested in exploring Medicare Advantage plans and discovering more about the supplemental home benefits mentioned in this article, feel free to reach out to our team today. Our experts can assist you in searching for plans available in your area, providing valuable information to help you make an informed decision. Whether you have specific preferences or require guidance on plan details, we're here to support you in navigating the options and finding a plan that aligns with your healthcare needs. Give us a call, and let's start the journey towards understanding and choosing the right Medicare Advantage plan for you.