One of the many obstacles people face when considering long-term care options is cost. What will you or your loved one need? What will the level of care be? Medicine? Surgery? All of these are important questions to ask when preparations to a long-term care facility are being made. It can be incredibly intimidating to consider such inquiries because one might have to consider future care options as well as the present needs.
With all of this in mind, one good thing is that families can rely on insurance to cover some costs in long-term care facilities, specifically Medicare and Medicaid. It is important to understand what options are available to you, that way you can be sure that Bay Vista Assisted Living is the right place for you or your loved one. We will briefly discuss the difference between the two, whom each plan benefits the most, and how they differ in nursing homes versus assisted living.
Medicare vs Medicaid: The Basics
Insurance is one of the many ways people can cover the cost of long-term care. There are private policies as well as federal ones, like Medicare or Medicaid.
Medicare is a federal health insurance plan for people aged 65 and older as well as people with certain health conditions under 65. It is run by Centers for Medicare & Medicaid Services. Bills are partially paid by those within the program in terms of monthly premiums, coinsurance, and deductibles. Because Medicare is a federal funded program, it has set standards for eligibility and coverage. In other words, no matter what state you live in your cost of coverage will not vary.
Medicaid on the other hand is both state and federally funded. It’s a program whose purpose is to aid those with medical costs and limited income and resources. Because this is a joint program, what is covered varies greatly. Although the program has federal guidelines each state must follow, overall the state runs the program based upon their own terms and conditions. This program tends to cover more than Medicare because of the flexibility of coverage. In other words, Medicaid will cover nursing home care and personal care services. Although not 100%, people with Medicaid don’t usually have to pay out of pocket for covered medical expenses.
Nursing Home vs Assisted Living
Now that we’ve covered the basics of the two most popular forms of insurance coverage, let’s differentiate between the two most popular long-term care options.
A nursing home is what most of us think of when it comes to life after 65. Also called a skilled nursing facility, it’s more of a medical environment than residential because patients often require higher levels of care in nursing homes. People tend to have limited mobility and serious health conditions that require constant staff supervision and 24-hour medical staff.
Assisted living is often overlooked when it comes to long-term care. Think about these facilities as shared communities for independent seniors. They are reserved for those who have minor health conditions and can move around freely on their own. People who reside here often seek to grow their social skills and connect with other members in their age group. Assisted living facilities tend to be more social and offer a plethora of activities. Although some do offer medical care, assisted living facilities might instead provide transportation services for seniors to their doctors appointments.
Insurance, Nursing Homes, and Assisted Living
Now that we have a basic understanding of insurance and long-term care facilities, the next question one might ask is: what covers what?
Firstly, understand that the cost of assisted living will greatly depend on what level of care is needed. Essentially, the healthier one is the cheaper long-term care might be. Factor in location, services, and amenities and now the cost of long-term care varies even more.
Medicare/Medicaid and Nursing Homes
As previously stated, Medicare is a federally funded program with little to no flexibility in terms of coverage. The program does not cover any costs associated with nursing homes or other long-term care facilities. Custodial care, things like eating and dressing, are not covered by the program if that is the only care needed. Any activities that do not require skilled nursing will not be covered by Medicare.
That being said, the insurance program does offer individual plans with benefits that the original Medicare plan doesn’t. These plans allow people more access to coverage.
Medicaid on the other hand will cover the cost of nursing homes for those that meet the specific financial and care requirements based on their state. Remember that Medicaid is a joint insurance program through the federal government and the state you live in. This means that the specifics of coverage will vary from state to state.
Medicare/Medicaid and Assisted Living
Most care offered within an assisted living facility is what Medicare considers custodial care. As mentioned above, this is care that does not require a skilled professional to perform like bathing and eating. However, transportation to and from medical appointments might be covered. At Bay Vista Assisted Living we pride ourselves on offering a vast array of services and amenities, such as physical and occupational therapy. Both services require skilled-nursing, which Medicare can cover.
Medicaid can cover the costs that Medicaid doesn’t. Because it’s a joint program between the federal government and the state, who qualifies will vary greatly. Certain individuals will qualify based on their income and the level of care needed in an assisted living facility.
With a basic understanding of insurance coverage when it comes to long-term care, now you can consider the question of which is right for you.
If you or a loved one require a higher level of care or have a serious medical condition that requires the supervision of a professional, then a nursing home might be the best option for you. Medicare and Medicaid can be used but it’s important to check with your plan and facility to ensure what costs are and are not covered.
If the level of care is mild/moderate, if there is little to no serious health condition present, or if you’re looking for a way to live dependently independent then an assisted living facility might be the best choice. The cost of assisted living varies greatly, not only through insurance coverage but also by location. Some facilities offer certain amenities and services that could affect the overall cost. When considering assisted living, it’s important to keep in mind what facilities best match what you need now and how they can help you prolong independence.
Bay Vista Assisted Living : The Best Long-Term Care in New York
Because assisted living facilities require less skilled-nursing care than nursing homes, they tend to cost significantly less. They also provide more physical activities for seniors than nursing homes. Bay Vista offers an array of activities and amenities that our seniors thoroughly enjoy, such as reading in the library or relaxing on the beach. We also offer therapy services to help our residents improve their overall health. We prioritize our seniors and we know how important it might be for some to maintain their independence while in our care.
The staff at Bay Vista are highly-skilled individuals that are ready to meet the need of every resident. We pride ourselves on meeting our seniors where they are and molding our care and services to their evolving lives. For further information about our services and programs, please submit an inquiry form on our website or give us a call at 1-516-897-1200