Medicare and Medicaid | When do they apply to senior housing?
The question of how to afford long-term care weighs heavily on the minds of every senior and their family. There’s no single answer, but we encourage you to explore state and federal resources such as Medicare and Medicaid. While these benefits vary from state to state, they're often among the most valuable resources for seniors. Below we explore the basics of both. If you have additional questions, contact your nearest Oasis Senior Advisor.
Medicare doesn’t cover custodial long-term care, but it does help with a variety of medically necessary housing options. Below are the medically related services that Medicare covers. Click to explore the qualification requirements and the scope of the coverage.
- Care in a long-term Care Hospital
- Skilled nursing care in a Skilled Nursing Facility
- Eligible Home Health Services
- Hospice and Respite care
It’s challenging to discern when Medicaid is available for long-term care because of the different forms of Medicaid waivers. Most commonly, states use Medicaid HCBS Waivers (Home and Community Based Services, sometimes referred to as State Plan Medicaid) to provide assisted living services. But some states use additional waivers that are the product of legislation.
In order to be eligible for Medicaid, you must meet the requirements for an eligibility group covered by your state’s Medicaid program. The requirements in most states are grouped into two categories: general and financial. For general requirements, you will likely need to prove the following:
- You are age 65 or older.
- You have a permanent disability under the terms defined by the Social Security Administration.
- You are blind.
- You are pregnant.
- You are a child, or a parent or caretaker of a child.
- You are a resident of the state where you apply.
- You have a Social Security number.
- You are a U.S. citizen or meet certain immigration rules
In 2018, financial requirements for many state waivers allow a monthly income of $2,250, but State Plan Medicaid may limit income to $750 a month.
While the above information reflects general information regarding Medicaid, assistance levels and specific details vary state by state. Not all assisted living facilities accept Medicaid payments. You will need to check with your local Oasis Senior Advisor or contact the facility directly. Keep in mind that a facility that accepts Medicaid will be licensed by the state and subject to periodic inspections to ensure it meets federal standards. For more information specific to your state, visit the Medicaid site.