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WILL MY INSURANCE COVER THE COSTS OF AN ASSISTED LIVING FACILITY?

 
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The first question many will ask when considering moving into an Assisted Living Facility (ALF) is will my insurance pay for it? Assisted Living Facilities accept a wide range of insurances from different companies.

Will Medicaid cover the costs of an ALF?

Coverage costs and acceptance of insurances vary state to state. Some states have regulations for ALFs to accept Medicaid, while others are in negotiation towards accepting Medicaid. Medicaid insurance does not always cover the full cost of an ALF. Certain services are covered, such as personal and medical care, while room and board often are not. Room and board will need to be covered by another type of insurance or with personal savings.

Will Medicare cover the costs of an ALF?

Individuals with Medicare are often surprised to find that Medicare coverage does not cover an ALF stay. Like Medicaid, Medicare only covers certain areas of care. Room and board are not covered by Medicare.

Private Insurance

Private insurance may or may not cover the cost of an ALF. When choosing a policy, ask about long term care and what services are covered by the insurance package you are considering. Even long term insurance can fall short of what is needed.

If you have long term care insurance the first step is to check with your chosen facility to ensure that they accept coverage from your company. If a policy is not clear, or is in any way confusing, always ask for clarification! Some insurers may push a package that has a high deductible – such as paying for your own ALF stay for the first year. This means that the entire cost of that year will need to be paid for out of your pocket.

When Costs Exceed Coverage

As you will glean, sometimes the cost of an Assisted Living Facility will be more than what an insurance policy will cover. Prices of Assisted Living climb yearly and a long term care plan purchased years ago may not fill the entire financial need.

Some states have plans in Medicaid that can fill this gap – if the facility accepts Medicaid. If you want to know if your facility of interest accepts Medicaid, ask to speak with the Administrative staff of the ALF to find out if this type of Medicaid coverage is accepted.

When choosing an insurance policy, try to go with a well known company. The higher profile the company, the more likely it is that your facility will accept the insurance. Some smaller companies that are not well established may be denied.

 

For more information and resources on Assisted Living Facilities, please visit LivingSenior.com’s Articles page, and scroll down to the Assisted Living section.