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Debunking the Myth: Medicare Pays if I Run Out of Money

This unfortunate myth has been swirling for decades. Let’s put aside the current discussion of whether or not the Medicare trust fund will become insolvent in the next few years and focus on the myth itself. Medicare does not pay for your care if you run out of money.

Many times, people confuse the benefits of Medicare with the health coverage provided by Medicaid. Enrollment in Medicaid is usually dependent on the financial situation of the recipient. Florida’s Statewide Medicaid Managed Care program is privatized, meaning eligible, low-income participants must apply for benefits and choose an approved provider in their area (Brevard County is in Region 7).  Some people qualify for both Medicare and Medicaid.

Medicare card

Generally, Medicare is an entitlement program for people 65 or older that provides fee-for-service health insurance in two parts – Part A and Part B. Medicare also pays for some people under age 65 who have a disability.

Part A helps cover:

Part B helps cover:

Part A does not have a monthly premium if you or your spouse paid Medicare taxes while working, also known as Premium Free Part A. Part B services require a standard premium amount. Additionally, Medicare Advantage plans (Medicare Part C – offered by private insurers) and Medicare Part D (prescription drug coverage) may offer extra benefits or lower drug costs while having lower out-of-pocket costs than Original Medicare.

Between deductibles and shared costs, there are healthcare-related expenses to be paid by any individual using Medicare benefits. Original Medicare, or an appropriate Medicare Advantage program, is not meant to be the primary payor in anyone’s aging plan. More than likely, healthcare is going to be a big expense in retirement.

Does Medicare Pay for Senior Living?

Medicare does not pay for senior living. However, Medicare does cover some services that support seniors living in independent, assisted living, and memory care communities. Residents in senior living facilities can use their Medicare benefits to obtain therapy services such as physical therapy, occupational therapy, and speech therapy among other services.

Hospice is an invaluable service covered by Medicare that supports the aging individual in their senior living apartment through the end of life. This homebound service recognizes the importance of friends, family, and familiar surroundings as an integral part of a senior’s final days. Care and oversight can be provided in a senior living apartment, meeting stringent state regulations and providing gentle guidance through the dying process and beyond.

Additionally, Medicare will continue to pay for prescriptions, surgeries, doctor’s appointments – including approved mobile medical providers – screenings, and medical equipment, just as it did when you lived at home.

Lady on beach

Will Medicaid Pay for Senior Living?

Medicaid does not pay the entire cost of senior living. Each Medicaid provider is reimbursed for care services by the managed care program at a pre-set amount determined by an approved schedule of fees. (The current reimbursement rate for Assistive Care Services in assisted living facilities in Florida is $13.37/day.) Each program also has a pre-determined monthly amount paid for care services to the facility directly. Depending on the program and the area, this could be up to $1500.

The Medicaid recipient or their family is responsible for covering the remaining costs, including Room and Board (often called Shared Costs).

Medicaid recipients of the Florida Statewide Medicaid Managed Care program work with their health plan to choose an approved senior living provider. Only an assigned Medicaid Case Manager through the chosen health plan can approve senior living providers for the Medicaid recipient. Not all providers are contracted with managed care health plans, so options can be limited.

Also, Long Term Care Medicaid benefits are not immediate. Not only is there an application process, but there is a waitlist of eligible individuals in need of funding. Bottom line – when it comes to Medicaid, plan ahead.

So How Do I Pay for Senior Living?

It is never too early to start preparing for senior living for yourself or an aging parent. It is important to understand senior living options and what each could potentially cost so that the goals established in your plan can be realistic. Staying at home is the top priority of most seniors, but the reality is the cost and coordination of services needed to ensure safety can be cost-prohibitive.

Additional Ways to Pay for Senior Living

Veterans Benefits

Medicaid Planning

VA Aid and Attendance benefit eligibility is determined by the Veterans Administration. An elder law attorney accredited by the VA is an invaluable resource to assist you in handling your application. There are other benefits, including funeral benefits, that a knowledgeable elder law attorney can assist you with to ensure your veteran receives the care and concern they deserve.

The sooner you begin Medicaid planning, the better. Medicaid eligibility is complicated – it is so much more than just filling out an application. While some cases may be easy, others can be quite complex, and creating a plan to avoid a crisis will pay off in ways you never expected.

How Do I Start an Aging Plan?

It may not seem to be a cheerful topic, but thinking about your plan for life after retirement can offer peace of mind to you and your family. What are your goals for aging – staying at home? Luxury assisted living? And who will make these decisions for you in the event you are no longer able to communicate your wishes?

Start with an appointment for an elder law attorney to memorialize your wishes in writing with advance directives. Be sure your family knows your documents have been completed and where they can be found. Create an emergency binder with your most important documents and keep the binder in a fireproof safe at home or in a safe deposit box at your bank. In the event something happens to you, be sure one person knows where the binder is and how to access it.

Financing Your Aging Plan

The next appointment you may want to make is with a qualified financial planner. Once you have considered a plan for aging, learning more about what it will cost to finance that plan will put your goals in perspective. Review your documents regularly, and if changes need to be made, adjust accordingly. An aging plan is a dynamic document – constantly changing and evolving with you as your needs and wishes change.

Cheers to medicare

Medicare and Medicaid will continue to experience changes in funding and breadth of services. Relying on these entitlements to fully fund your healthcare needs is an unrealistic expectation. The time you spend planning for the future will pay off in a time of crisis, for you and your family. Keep your options open by staying informed about the resources that are available and educating yourself on which ones are best for you.

No matter where you are in your aging journey – you are not alone. There are professionals who stand ready and willing to help you as you navigate the matters of aging. There is no shame in asking for help. Learn more about the senior resources of Brevard County, Florida on our Resources We Love page, and stay informed with our short, easy-to-read Blogs, including Legal and Financial, Resources, and Senior Living Options.

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