The senior care industry is growing almost as quickly as the senior population itself. The number of Americans ages 65 and older is projected to nearly double from 52 million in 2018 to 95 million by 2060 — and those residents will need various levels of care. If you’re weighing senior care options for yourself or a loved one, it’s important to learn what each type offers, which will work best for your situation, and what insurance will cover.
To help you, we’ve defined and compared the types of senior care available, unmasked what Medicare covers and doesn’t cover, and described how supplemental insurance policies can help fill in coverage gaps so you’re always well protected. It’s important to note that supplemental insurance coverage depends on your state of residence. Read your policy carefully to make sure your circumstances qualify. With that in mind, let’s get started.
Twenty percent of 65 year-olds will need care support for longer than 5 years. The difference between skilled and custodial care is that skilled care is medical care performed by a licensed professional, and custodial care (also called long-term care) is performed by a person not medically certified who helps individuals with basic elderly care, such as bathing, feeding, and dressing. Either type of senior care can take place in patients’ homes, nursing homes, assisted living facilities, or in adult daycare settings. Generally, Medicare only covers skilled care received in a skilled nursing facility. Custodial care falls under personal, non-medical care that is not covered by insurance. However, Medicare Supplement plans may be able to help cover skilled care copayments and deductibles.
According to the National Institute on Aging, long-term care helps seniors perform daily tasks, like bathing and meal preparation, whether they live at home or in a nursing home. Short-term care insurance helps cover the cost of different types of care for up to 360 days. It can be used to recover from an illness or injury or to transition from living independently to receiving assisted care at home or in a facility. Medicare and Medicare Supplement insurance don’t cover long-term or short-term care that isn’t medical in nature.
Assisted living and memory care facilities provide services, such as meals, organized social activities, nursing care, and transportation. The difference between the two is memory care facilities serve individuals with dementia or Alzheimer’s disease and have tighter security to prevent individuals from leaving on their own. Subsequently, this type of care costs more. Medicare generally doesn’t cover assisted living because most of the services fall under custodial care. Similarly, Medicare doesn’t cover custodial care for individuals with early-stage Alzheimer’s or dementia, but as their skilled-care needs grow, so does the level of Medicare coverage.
Senior care provided at your home falls under one of these categories. Non-medical home care is the same as custodial care, which is provided by a person not medically certified who helps with daily tasks, such as household chores. This type of care is not covered by insurance. Home health care is provided by a skilled individual with medical training who performs tasks like operating medical equipment and checking vital signs. Since these tasks are medically necessary, they’re commonly covered by Medicare and Medicare Supplement plans. If you are homebound, other aspects of care also may be covered.
Adult daycare may be a good option for you if your primary caregiver goes to work. It provides social interaction and meals in a setting with other seniors. An adult day health care facility offers medical care as well. Adult daycare is not covered by insurance, but some plans will cover adult day health care. Check your policy to be sure.
Independent living communities offer seniors amenities, like security, social activities, meals, transportation, and laundry services, but they don’t offer medical care. Residents pay rent, similar to an apartment. Virtual companion care provides security and socialization via internet monitoring in your home for a fee. Virtual care is generally a cost-effective means of receiving elderly care without medical assistance. Neither independent living nor virtual care is covered by Medicare or supplemental insurance plans.
Palliative care focuses on relieving pain and suffering rather than curing or treating chronic conditions. Hospice care aims to make the end of terminal patients’ lives more comfortable. While hospice often includes palliative care, not all people who receive palliative care are in hospice. Medicare and supplemental insurance generally cover palliative care that is performed in hospitals, rehabilitation clinics, skilled nursing facilities, or hospices. Once you make the decision to start hospice care, Medicare will not cover any treatments intended to cure your condition, but it will cover the hospice care itself. Supplemental plans can help cover copayments and deductibles.
Nursing homes differ from assisted living communities by the level of medical care offered and the range of independence residents have. Nursing homes offer 24-hour medical care and personal assistance for residents who are medically or physically limited. Assisted living facilities offer less medical care and more independence for residents. Continuing care retirement communities (CCRCs) provide a campus-like setting with a tiered approach to housing options, including independent living, assisted living, and nursing home environments. They are the most expensive long-term-care option, and often require a hefty entrance fee as well as monthly charges. As stated previously, Medicare and supplemental insurance won’t cover non-medical assistance, but they will cover some ongoing medical treatment. Double check what Medicare covers for your particular situation.
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Kelly Rayburn, AVP national sales and distribution at Wellabe, and Olga Villaverde, from Lifetime TV’s The Balancing Act, discuss the areas that primary health plans and Medicare may not cover and how you can protect yourself with supplemental plans.
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