Ask the Expert: How Do I Pay for Assisted Living?

Dear Jaclyn,

I’ve been considering moving to an assisted living community for some time now. However, I have some questions about how I will pay for it. What are my options? Does Medicare cover assisted living?

James K.

Columbus, OH

Paying for Assisted Living

Dear James,

Many people have questions about how to pay for assisted living. To help clear things up, let’s go over some of the most common ways people cover the cost of an assisting living community.

Out of Pocket

Almost all assisted living communities are private-pay. Medicare and most private health insurance plans do not cover assisted living, so you will likely need to pay out of pocket if you live in an assisted living community.

However, there are some things that can help you pay for assisted living, which I’ll go over below.

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Related: Ask the Expert: How Much Does Assisted Living Cost?

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Medicaid

A few (though not many) assisted living communities accept the Ohio Medicaid assisted living waiver. For example, Whetstone, an assisted living community in Columbus, will accept the Medicaid waiver.

Here’s how it works: once a resident spends down their funds, they can apply for the assisted living waiver. However, they must first have completed two or more years of private pay before this option is available. If they are still a good fit for assisted living after that period, they can transition to the Medicaid waiver, which can help with the cost of assisted living.

Medicare

Medicare will not pay for assisted living. However, there are some services you may receive while in assisted living that could be covered.

For example, Medicare Part B covers certain types of home health care. Say you needed physical or occupational therapy after a health setback and received services in your assisted living apartment. That would be covered by Medicare because your assisted living apartment is your home.

Long-Term Care Insurance

If you have long-term care insurance, most assisted living communities will accept it. Coverage varies by plan, but it typically covers a large portion of your cost. If you have long-term care insurance, I recommend you utilize it.

As I mentioned above, private health insurance plans do not usually cover the costs of assisted living. However, long-term care insurance is different from traditional health care insurance.

According to the U.S. Department of Health and Human Services, “unlike traditional health insurance, long-term care insurance is designed to cover long-term services and supports, including personal and custodial care in a variety of settings such as your home, a community organization or other facility.”

Veteran’s Benefits

If you are a veteran, your VA benefits can help cover the cost of assisted living through the aid and attendance pension. For eligibility and coverage questions, call the Veterans Affairs office about your VA benefits and health care.

This is a benefit that many veterans don’t realize they have. The best part is, it applies to spouses of veterans, too.

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Related: Cost Comparison Worksheet: Assisted Living vs. Staying at Home

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Financial Resources for Assisted Living

Many of our residents work with an attorney or financial advisor to sort out how they will pay for assisted living. We can provide referrals to elder law attorneys if you do not currently have one. An elder law attorney can help you with health care planning, financial planning (such as establishing a power of attorney) and more.

On our end, we collect your financial application and answer any questions you may have about costs and what’s included in assisted living.

We always go over your finances with you to ensure that you are a good fit and will be able to afford the cost of assisted living. This is a very important step of the process. At some other communities, you aren’t required to meet any financial obligations prior to moving in and when that’s the case, you run the risk of being asked to move out down the road due to financial issues.

If you have any more questions, feel free to contact us and we’ll be happy to help.

Jaclyn Spalding
Assisted Living Director
Whetstone Rehabilitation, Skilled Nursing & Assisted Living