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Does Medicare or Medicaid Pay for Assisted Living in San Diego?

December 2, 2022
Medicare Pay for Assisted Living

Assisted living can be a great option for older adults who are looking to live independently but need some help with day-to-day tasks. The question is, how can you pay for assisted living?

Medicare and Medicaid both provide coverage for some care services, including in-home and residential care. However, Medicare does not cover assisted living services where Medicaid may help, but with some restrictions. In this post, we will explore if either of these programs covers the cost of assisted living in San Diego and other ways you can pay for this critical service.

California has some specific Medicaid pay for assisted living in San Diego options that we’ll also take a look at.

What are Medicare and Medicaid?

Medicare and Medicaid are two government-funded health insurance programs. Medicare is for people who are 65 or older or who meet certain disability requirements. Medicaid is for people who have low income and resources.

Depending on their income, people who qualify for these programs might pay no premium. For example, a person making less than $1,359 per month may not pay a premium at all. However, someone earning more than that amount but less than $2,655 per month will pay around $94 per month (as of 2018).

After the Affordable Care Act, these income limits have been drastically adjusted, and there is a public marketplace for available insurance programs that may work directly with Medicaid and Medicare.

Our team at Huntington Manor can go over these programs in detail more, or you can request the aid of a social worker to help navigate the system.

Do Either Cover the Costs of Assisted Living?

Medicare and Medicaid are government-sponsored healthcare programs that are available to Americans in need. They both have precise eligibility requirements, but they each offer different services. 

Medicaid is a needs-based program that helps ensure low-income individuals receive coverage for their medical bills, while Medicare is a senior citizen health insurance program that provides assistance with medical costs but does not cover long-term care specifically.

The difference is that Medicare is better for covering supplemental services you may require while living in a long-term community. These include medication, medical office visits, complimentary health services, physical therapies, mental health therapies, and outpatient care. There is an exception.

Medicare can cover the cost of Hospice care when at-home. This is a special kind of service that focuses on the quality of life for those patients experiencing an advanced or life-limiting illness.

With Medicaid, you can get some support for long-term care, but there are restrictions depending on which state your community is based in and your specific income level. You’ll need to speak with a financial expert in the community you wish to attend to understand how Medicaid will be applied to your particular needs.

Most of the time, if you are using Medicare A or B as part of your funding plan for long-term care, it will be applied to any approved prescriptions, necessary surgeries, doctor’s appointments, medical screenings, or medical equipment you may need. This could be something like an aid in the restroom or even a cane for moving around the community.

The best way to find this information about how Medicare or Medicaid help cover some costs for assisted living in San Diego is to speak with a state representative from your plan.

What Other Ways are there to Cover Assisted Living Costs?

If you’re not eligible for Medicare or Medicaid, there are still some options to help pay for assisted living.

  • Private insurance may cover some of the cost of assisted living. Contact your insurance provider to see if they offer any assistance with these costs and how much they will pay each month.
  • Medicaid waivers are state-funded programs that may be available to you if you don’t qualify for full Medicaid but still need financial help paying your bills. They can give access to community-based services, including meals and transportation, as well as other types of support like case management or health care coordination.
  • You can reach out to your family members to help with the costs.
  • You can sell your home if you plan on moving into a facility full-time.
  • And many others.

What About a Medicaid Waiver?

There’s another option for people who don't qualify for Medicare or Medi-Cal. It's called the Medicaid Waiver program. The Medicaid Waiver is a special program that's designed to cover care costs for low-income individuals with disabilities.

California does its best to ensure everyone, regardless of personal position, are able to have a good quality of life. The Assisted Living Waiver Program (ALWP) serves those seniors who may need long-term care assistance with personalized care and household tasks. Again, this may not cover the total cost of long-term care but can help with supplemental services, equipment, and appointments to lower your overall health-related expenses.

Not every county will take these programs, but you can always reach out to the facility in question to learn if they allow Medicaid pay for assisted living in San Diego.

Work with the Huntington Manor Team

The Huntington Manor team is here to help you. We can help you get the most out of your assisted living experience, as well as your financial situation and Medicare and Medicaid benefits. We’ll also work with you to make sure that whatever investment you make in our community is an informed one.

Our goal is a stress-free transition into a new living situation where you or your elderly loved one is able to have peace of mind in their financial obligations. Schedule a time to meet with our experts or tour our beautiful Huntington Manor facility.

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