Medicare, Medicaid and Long-Term Care Insurance: Who Pays for What?

One of the most common questions families ask is: “Will Medicare pay for memory care?” The short answer is no, but other programs may help. Here is a guide to who pays for what.

Medicare

Medicare is health insurance for people 65 and older. It pays for doctor visits, hospital stays, tests and many prescription drugs. It does not pay for long-term personal care, such as help with bathing, dressing and supervision, or for room and board in assisted living.

• After a qualifying hospital stay of at least three days as an inpatient, Medicare may cover a limited stay in a skilled nursing facility for rehabilitation, up to 100 days, with a daily copay after day 20.
• Medicare covers hospice care for people with a terminal diagnosis, including those with advanced dementia, and hospice can be provided in an assisted living home.
• Medicare’s GUIDE Model, launched in July 2024, is testing new ways to support people with dementia and their caregivers through participating care programs.

Medicaid

Medicaid is a joint federal and state program for people with limited income and assets. In Florida, the Statewide Medicaid Managed Care Long-Term Care program can help pay for care services in assisted living, including memory care, for people who qualify. It generally doesn’t pay for room and board. There is often a wait list, so call the Florida Elder Helpline at 1-800-96-ELDER (1-800-963-5337) to be screened early.

Long-term care insurance

Private long-term care insurance policies can pay for assisted living and memory care when a person needs help with daily activities or has a cognitive impairment like dementia. Check the daily or monthly benefit, the waiting (elimination) period and whether assisted living is covered.

VA benefits

Wartime veterans and surviving spouses who need help with daily activities may qualify for the VA pension with Aid and Attendance, which can help pay for assisted living.

Private pay

Many families pay with savings, retirement income, the sale of a home or help from family, often combined with one or more of the programs above.

Generations Senior Living accepts Medicaid at all three of our homes, accepts long-term care insurance and helps families with claims.

Have questions about memory care for someone you love? Call Generations Senior Living at (352) 474-2696 or schedule a tour of one of our three homes near The Villages.