Assisted living or at-home senior care can be popular and sometimes even necessary options for older adults who require some assistance completing their Activities of Daily Living. However, the cost of assisted living or at home senior care can be very expensive and so it’s important that seniors and their families explore all their options for paying for senior living and senior care, including all the government funded programs that are available. For seniors with limited financial resources there are two main government funded programs that can provide access to care: Medicare and Medicaid. While both programs are designed to help eligible seniors with medical expenses, they differ in terms of who is eligible, how you can apply and pay for care, what services and treatments are covered, and how the programs are funded. 

Check out our article below to learn about all the differences between Medicaid and Medicare for seniors, or reach out to Sunbound to learn more about how Sunbound can make paying for senior living cheaper and easier.

Medicaid

Medicaid is a government-funded health insurance program that helps provide coverage for (among other people) seniors aged 65 and above who meet certain financial and health-based criteria. Medicaid can cover the cost of various healthcare services, including hospitalizations, prescription medications, and long-term care in nursing homes or assisted living facilities, just to name a few of the benefits provided by Medicaid. While Medicaid uses funding from the federal government, each state administers its own Medicaid-funded health care program and therefore has its own set of eligibility criteria. 

While each state has its own specific criteria and application processes, generally in order to qualify for Medicaid, seniors must meet certain financial and medical criteria. In terms of finances, seniors must have limited income and assets with the exact limits being set by each state. Seniors must also be U.S. citizens or legal residents and reside in the state where they are applying for Medicaid. As for medical criteria, generally states require that seniors demonstrate a need for assistance with activities of daily living (ADLs) such as bathing, dressing, and grooming. Additionally, having a medical condition or disability that requires ongoing care, such as Alzheimer's disease, Parkinson's disease, or mobility limitations, will also satisfy most state’s medical qualifications. 

While Medicaid can be a valuable resource for seniors who need assistance with paying for assisted living, there are some limitations to keep in mind. Firstly, not all assisted living facilities accept Medicaid. Seniors must find a facility that is Medicaid-certified in order to receive coverage. Additionally, there may be wait times for Medicaid approval and for placement in a Medicaid-certified facility. In some cases, seniors may need to wait several months before they can receive assistance. It's also important to note that Medicaid may not cover the full cost of assisted living. Seniors may need to pay a portion of the cost out of pocket, and the amount they are responsible for will vary depending on their income and assets. 

If you or a senior loved one are thinking about applying for Medicaid, contact your state's Medicaid office or local Department of Social Services. In most cases senior applicants will need to provide documentation of their income and assets, as well as any medical conditions and need for assistance with ADLs. The application process can take several weeks or months, and seniors should be prepared to provide additional documentation or information as needed.

Medicare

Another important government program that provides health insurance coverage to seniors over the age of 65 is Medicare. Medicare covers a variety of services and treatments and is broken into four parts – Medicare Part A, B, C, and D. Each Medicare Part provides coverage for a different set of services as outlined below.

Medicare Part A

Medicare Part A provides hospital insurance for eligible seniors, which not only includes care provided at a hospital but also at a medical facility like a skilled nursing facility. In certain circumstances, Medicare Part A can also cover the cost of hospice care or at-home health care. Generally, individuals do not pay a monthly premium for Medicare Part A coverage because they (or their spouse) has worked the requisite number of days, and paid the requisite amount of Medicare taxes, to be covered. 

Medicare Part B

Medicare Part B provides medical insurance for standard medical services such as visits to the doctor or diagnostic or lab tests. While Medicare Part B coverage is optional, many seniors elect to get Medicare Part B coverage due to the amount of value provided for the relatively low monthly premiums. These premiums are set according to an individual’s income, with higher income individuals paying slightly higher premiums. 

Medicare Part C

Medicare Part C plans, also known as Medicare Advantage Plans, are Medicare plans that are offered by private insurance companies according to rules set by Medicare. These provide the same benefits as Medicare Part A and Part B, but can also provide additional benefits and services that are not covered by Medicare Part A and Part B like some vision, hearing, or dental services or fitness programs like gym memberships. When you get coverage under a Medicare Part C Advantage Page you are still a part of the Medicare program. This means that in addition to pay for your Medicare Part B premiums, you will generally also have to pay a premium for your Medicare Advantage Plan.

Medicare Part D

Finally, Medicare Part D is a voluntary program that provides coverage and access to prescription drugs. Medicare Part D plans are provided by private insurance companies in contract with the federal government, and generally require participants to pay a monthly premium. A Medicare Part D plan can provide supplemental prescription coverage to individuals receiving coverage through either traditional Medicare (Part A and Part B) or a Medicare Advantage Plan (Part C). Medicare Part D plans must cover a wide range of prescription drugs, and provide different pricing tiers based on the particular medication.   

To learn more about how Sunbound can help make paying for senior living and senior care more affordable for you or your senior loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care, and we’re on a mission to make senior living and senior care more affordable for everyone.