Is A Memory Care Facility Covered by Medicare?

Morning, Toni:

I have never seen you address the issue of paying for a Memory Care or Alzheimer facility and Medicare.  I am concerned that I may wipeout my 401K or savings if need arises due to a long-term health issue or if Alzheimer/dementia need arises for me or my wife.

Currently, my 88-year-old mother has been living in an Alzheimer’s facility for 3 years, costing me and my siblings over $7,000 each month. Is there any help we can get for her financially? Thanks, Roy from Memorial/Spring Branch area.

Roy:

I’m sorry, but Medicare does not cover Alzheimer, Memory Care, Assisted Living or Nursing Home stays,  Medicare will only pay Skilled Nursing/Rehab days 1-20 with a $0 co-pay and days 21-100 have a specific co-pay per day that changes each year.

After that time, the Medicare beneficiary or their family must absorb the remaining cost themselves or if there is a Long-Term Care type policy then it can help to pay for a specific amount of the care as stated in the policy.

A recent study showed that one in seven Americans over the age of 70 have some form of dementia and that the number rises to one in three Americans over the age of 85.

I am also beginning this Medicare situation with my mother who has dementia and needs additional at home care.  She was denied Veteran’s assistance due to making $50 too much on her Social Security check and now I also must pay out of pocket for extra at home care.

The 2019 average Long-Term Care annual cost ranges from $60,000 to $85,000 per year for semi-private nursing home stay and over $80,000 to $93,000 per year for private nursing home stay.

Boomers need to be aware that the cost of long-term care is projected to rise in 10 years to over $131,000 per year and growing to over $176,000 in 20 years.

Senior living options can be difficult for the adult child to navigate to help their parents.  Options include independent living, assisted living and memory care communities providing care with each catering to a different type of individual.

Knowing when a loved one needs memory care over assisted living and independent living over memory care can be confusing.  As the individual’s needs change, so do their needs from their living environment.

Memory care communities are growing because dementia is growing due to diseases such as Alzheimer’s, Parkinson’s, MS and cardiovascular issues. These assisted living communities help residents with issues such as dementia living in a safe, homelike environment that caters to their mental needs. Memory care communities help with a range of needs including bathing, hygiene, feeding, incontinence, laundry, cleaning, medication management, mental stimulation and more.

As you and I are finding the only way to have long-term care issues covered financially is with a long-term care policy or pay completely out of your pocket.

Below are a few options for additional ways to find affordable long-term care or email info@tonisays.com or call 832/519-8664 for specific information to your long term care needs:

• Traditional Long-Term Care: The younger you are when you purchase a long-term care policy, the lower the premiums will be. Make sure that your policy covers care at home and facility care.
• Hybrid Life and Annuity Policies: Many life/annuity insurance policies have a provision if you have a long-term care need.
• Veterans Aid and Attendant Benefits: helps eligible veterans and surviving spouses to pay for the assistance they need in everyday functioning.

Toni is giving a $5 discount on the  Medicare Survival Guide® Advanced book for the Toni Says® newspaper article readers at www.tonisays.com. Call 832/519-8664 for personalized Medicare consultation.   Happy New Year from the Toni Says Medicare team!!