If you’re struggling to understand Medicare, Connie can help. Ask Connie your question and a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.
I’m helping my Mom choose her Medicare plan this year, and I am looking at planning for her long-term care. Because assisted living or nursing home care is likely in her future, I’m wondering, does Medicare cover assisted living?
Jennifer from Grand Prairie, Texas
It is good that you are helping your Mom navigate Medicare plans and thinking about her future.
It can be stressful and confusing to find the right plan and prepare for the future when things are uncertain. And if assisted living or nursing home care is likely, it is understandable that you want her to be comfortable and covered wherever she is.
Medicare does not typically cover assisted living or long-term care. She will still need Medicare to cover doctor services and hospital care even if she moves to an assisted living or nursing home care facility. Family members may pay out-of-pocket to cover the costs or get long-term care insurance to pay for the cost of assisted living or nursing home care.
If you qualify for Medicaid, Texas offers Medicaid waivers that can help pay for assisted living or a nursing home. You can visit yourtexasbenefits.com to find out if you are eligible for Medicaid. You can also go to Medicaid.gov to learn more about the available Medicaid programs in the Dallas-Fort Worth area.
Finding the right senior living option will depend on the type of care your Mom will need. These are the two most common options:
Medicare Part A covers skilled nursing facilities, which provide more extensive medical care than assisted living communities. Skilled nursing facilities offer medical care for recovering after an illness or injury and rehabilitative services such as physical, occupational, and speech therapy.
An individual may qualify for Medicare coverage at a skilled nursing facility if specific criteria are met:
Medicare Advantage plans in Texas may also cover nursing home care if the plan has a contract with the nursing home. You can ask your plan provider about nursing home care before transitioning to a nursing home.
“Medicare Part A covers skilled nursing facilities, while some Medicare Advantage plans cover nursing home care. You can search for Medicare Advantage plan providers that offer this extra benefit.“
Medicare Advantage plans may differ in Grand Prairie depending on your county. Grand Prairie is part of Dallas County and Tarrant County. In 2023, Dallas County offers 70 Medicare Advantage plans, and Tarrant County offers 69.
Connie Health has a plan comparison tool that sorts your numerous plan options in Texas. Simply enter your doctors, prescription medications, and desired benefits, and our technology will compare available plans tailored to your needs–quickly narrowing your choices.
If you’d like help ensuring that you pick a plan that best fits your mother’s needs, a local licensed Connie Health agent can help. Call (623) 223-8884 (TTY: 711), and an agent will find a Medicare plan to help you plan for the future.
Besides finding a living situation that best fits your needs, maintaining an active and social lifestyle can help improve your Mom’s quality of life. Grand Prairie has fitness and social programs for seniors at the Summit Center. Engaging in activities like gardening, fitness, or arts and crafts can help your Mom maintain her health.
Before transitioning to an assisted living facility or nursing home, check if it is a licensed and reputable. Assistedliving.org has a directory tool for comparing and reviewing the facilities in Texas.
While it may be worrisome, there are many available resources and options for you and your mom to find a facility that works for both of you and pay for long-term care costs. At Connie Health, we can help you find long-term care that provides an excellent quality of life. I wish you both the best. Should you have any additional questions or need help, please contact us at (623) 223-8884.
Last updated: February 27, 2023
No. Original Medicare Part A and Part B do not pay for assisted living, even for someone with dementia.
If you or a loved one needs to be in a full-time residential memory care facility, the financial responsibility would not be covered by Original Medicare. Family members typically pay out-of-pocket to cover the costs of memory care; averaging $48,000 per year.
Some Medicare Advantage plans cover long-term care costs, like personal care and assistance. When choosing a Medicare Advantage plan ensure that you review the Evidence of Coverage (EOC) to learn if the memory care products and services needed are covered.
Read more by Richard Torres
I am a Spanish-speaking Texas Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2016. I am a U.S. Army Veteran and served under Operation Enduring Freedom. I enjoy spending time with my family and coaching youth soccer and basketball.