Let’s Talk About Money. Navigating Senior Living Payments: What’s Covered, What’s Not

When exploring senior living communities, families often wonder why certain services are covered by Medicare or insurance while others are not. The question can be confusing and stressful. Our goal is to shed light on the different types of senior care available and give you an overview of how they’re typically paid for. If you have questions specific to your situation, please reach out—we’re here to help you navigate.

Independent Living
Brief Description: Independent Living offers a maintenance-free lifestyle with other 55+ older adults.
How It’s Paid For:
• Private Pay: Most residents use personal savings or retirement income.
• Long-Term Care Insurance: Rarely covers this living option, because no personal care or services like help with daily activities or medications are provided.
• Veterans Benefits (Aid & Attendance): May offer partial support for those who qualify.
• Medicare/Medicaid: Not covered because no skilled nursing services or rehab services are offered.

Assisted Living
Brief Description: Assisted Living communities provide help with activities of daily living, also known as custodial care—bathing, dressing, medication management—and [at Northern Lakes Senior Living] it include daily meals, daily activities and social programs, housekeeping, laundry services and 24/7 staff onsite.
How It’s Paid For:
• Private Pay: The majority of costs are paid from personal funds.
• Long-Term Care Insurance: Some policies help cover costs.
• Medicaid Waivers: Available in some states to assist with expenses (eligibility varies).
• Veterans Benefits (Aid & Attendance): May offer partial support for those who qualify.
• Medicare: Not covered because it’s considered custodial care, not skilled nursing.

Memory Care
Brief Description: Memory Care is a specialized form of Assisted Living designed to meet the needs of those with Alzheimer’s or other forms of dementia. These communities have trained staff, secure environments, and personalized programming.
How It’s Paid For:
• Private Pay: Common method of payment.
• Long-Term Care Insurance: Policies that include cognitive/dementia coverage may pay benefits.
• Medicaid Waivers: Some states extend waivers to cover Memory Care.
• Veterans Benefits (Aid & Attendance): May offer partial support for those who qualify.
• Medicare: Not covered beyond medical services; custodial care remains the family’s responsibility.

Short-Term Skilled Nursing
Brief Description: Often referred to as rehabilitation or post-acute care, Short-Term Skilled Nursing provides therapy (physical, occupational, speech) and nursing services following a hospital stay.

How It’s Paid For:
• Medicare Part A: Typically covers up to 100 days of skilled care per benefit period, if eligibility criteria are met.
• Private Insurance: May cover rehabilitative stays.
• Long-Term Care Insurance: Some plans cover short-term rehab.
• Medicaid: May cover if financial and medical eligibility are met.
• Private Pay: If other coverage does not apply.

Long-Term Skilled Nursing
Brief Description: Designed for residents who need around-the-clock medical oversight or have chronic health conditions requiring continuous skilled nursing care.
How It’s Paid For:
• Medicaid: A primary source for extended stays if the resident meets income and asset limits.
• Medicare: Covers limited stays for skilled care; not for indefinite, long-term residency.
• Private Pay: Some families pay out-of-pocket until they qualify for Medicaid.
• Long-Term Care Insurance: Policies may cover long-term skilled nursing.

Why Medicare & Health Insurance Focus on Skilled (Not Custodial) Care
• Medicare and most health insurance plans cover medical services, such as hospitalizations, doctor visits, and rehabilitative skilled care.
• Custodial care—help with bathing, dressing, and meal preparation—does not fall under Medicare’s standard coverage unless it’s part of a short-term rehab stay.
• Long-term care insurance can help bridge this gap for Assisted Living or Memory Care.

We are here to help talk through your family’s situation; to offer options and resources.