Maximizing Medicare Benefits for Senior Care
Discover how to get the most out of your Medicare coverage, optimizing financial support for medical expenses and senior living and care needs.
Cost is a significant factor in considering senior care. How much does senior living and care cost? Does Medicare cover any retirement living costs? To understand what senior care may be covered by Medicare, it’s important to thoroughly know what Medicare covers and how it can be applied.
What is Medicare?
Medicare is a federal health insurance program for U.S. residents who are at least 65 years old; the extent of coverage depends on specific criteria and circumstances. The Medicare program is divided into four different parts — Part A, B, C & D.
Medicare Part A - Hospital Insurance
Medicare Part A pays for inpatient hospital care, some skilled nursing, hospice, and home health care (if prescribed). Part A is premium-free for 99% of beneficiaries due to paying Medicare taxes while employed.
Medicare Part B - Medical Insurance
Medicare Part B covers outpatient physician and hospital services, some home health services, and durable medical equipment.
Medicare Part C - Medicare Advantage Plan
Medicare Part C allows private companies like HMOs and PPOs to offer health insurance that provides at least the same benefits of Parts A & B, but usually additional benefits, such as dental and vision.
Medicare Part D - Prescription Drug Coverage
Medicare Part D offers prescription drug benefits through private insurance companies at the cost of additional monthly premiums.
Skilled Nursing & Medicare Coverage
Traditionally, Medicare does not cover assisted living costs. While it will pay for most medical costs incurred while a senior is in assisted living, it does not cover any costs of personal care or room and board costs.
Although Medicare doesn’t cover assisted living costs, it can cover costs in a skilled living facility if certain requirements are met. Skilled nursing facilities are equipped to provide more medical care than what is offered at an assisted living facility.
Skilled Nursing & Medicare Coverage Requirements
To ensure Medicare coverage for Skilled Nursing communities, including Long-Term Care communities, Convalescent Homes, and Nursing Homes, the following four requirements must be met:
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Requirement 1 — Hospital Stay: The patient must have a qualifying hospital stay of at least three days as an inpatient.
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Requirement 2 — Admission to SNF: The patient must be admitted to the SNF within 30 days of discharge from the hospital for the condition treated during the hospital stay.
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Requirement 3 — Doctor’s Orders: A doctor must certify that the patient needs daily skilled nursing or therapy services.
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Requirement 4 — Medicare-Certified Facility: The SNF must be Medicare-certified.
If all conditions are met, Medicare will cover the costs of skilled nursing care for the first 20 days. After that, the patient will be partially responsible for days 21-100. Medicare will not provide any coverage after 100 days.
Medicare & Senior Living Expenses
If a senior transitions to a senior living and care community, Medicare will continue to cover the cost of their prescriptions, doctor’s appointments, surgeries, screenings, and medical equipment, just as it did while they were living at home.
Find Senior Care
For elderly individuals, it’s important to have the resources to find effective senior care services and senior living centers. Senior Care Finder is committed to providing all of the best resources to do this, by offering a wide range of resources in our directory. Explore our services page to begin your search to find sustainable and affordable solutions for senior living.
