What Does Medicare Cover?

Medicare is one of the most talked about items in relation to elder care, and still it is one of the most confusing for many people. Figuring out exactly what Medicare will and will not cover as it relates to your loved one’s living expenses is one of the most important steps in building a plan that secures their future. For those thinking about admitting a loved one to an assisted living facility, you’re undoubtedly wondering whether or not Medicare will cover their living expenses. While Medicare typically does not pay for assisted living facility costs, it is still a critical part of the elder care picture. Assisted living facilities provide a safe, secure, nurturing environment for your loved ones to live as independently as possible, and Medicare makes sure that critical expenses like hospital stays, physical therapy, and prescription medications are available when they need it. As one of our country’s largest medical programs, Medicare can seem daunting at first. Here is a run-down of what you need to know.

Medicare

Medicare was created in 1965 to provide federally funded medical care for people ages 65 and over, regardless of income, medical history, or health status. In 1972, the program was expanded to cover those with permanent disabilities, even if they did not meet the minimum age requirement. Medicare plays an integral role in the lives of over 55 million elderly and disabled, and helps pay for medical services including hospitalization, physician visits, prescriptions, post-acute care, skilled nursing facility care, home health care, hospice care, and many preventative services.

Medicare is made up of two parts: Part A, known as hospital insurance, and Part B, known as medical insurance. Part A of Medicare covers inpatient care, whether it be in a hospital, skilled nursing facility, or even at home in certain situations.

While most become eligible for Medicare Part A benefits at age 65 if they are already collecting retirement benefits from Social Security, you may also qualify before 65 if you have a qualifying disability, late-stage renal disease, and are a US citizen or legal permanent resident of at least five years.

In general, Medicare Part A coverage includes:

• Hospital care
• Limited home health services
• Skilled nursing facility care
• Hospice care

Medicare Part B is part of Original Medicare and covers services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulances, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, so long as they are ordered by a doctor to help treat your condition.

Medicare Part B covers some preventative services, such as a one-time initial physical exam, flu shots, hepatitis B shots, screenings of the cardiovascular system, diabetes screenings, cancer screenings, and others.

If you enroll in a Medicare Advantage plan, you would get both Medicare Part A and Part B coverage through a private health insurance company under contract with Medicare. By law, Medicare Advantage plans must offer at least the same level of coverage as Original Medicare, and some plans include additional coverage not included in Original Medicare.

While Medicare does not typically cover the costs associated with assisted living facilities, Medicare does cover qualified healthcare expenses while your loved one is living in a certain facility. Typically, Medicare is used to pay for skilled nursing facility services or home health care. There are outstanding circumstances that do allow Medicare to cover different types of care, but as a general rule, it will not cover what is considered “custodial care”. Though it doesn’t cover assisted living costs, Medicare is still vital to providing your loved ones with a safe and secure life in their elder years.

Assisted Living

Typically, assisted living facilities are most suitable for those who need assistance with their daily living activities but who also want to live as independently as possible for as long as possible. Assisted living facilities like Encore serve to bridge the gap between completely independent living and nursing homes, and as such, their residents are not able to live completely on their own with no assistance, but do not yet require the constant care of a nursing home either.

Assisted living facilities most commonly help with everyday activities like eating, bathing, getting dressed, doing laundry, housekeeping, and tracking medication usage. Many assisted living facilities have centers for medical care, though they typically are not as comprehensive as those found at a nursing home, due to differing needs of the residents.

Many see nursing homes and assisted living as interchangeable terms, but this simply isn’t the case. Assisted living is not an alternative to a nursing home, but instead is a long-term, intermediate step between living independently and needing intensive care. Here at Encore, we create a personalized plan for each resident upon their admission which outlines the services they require, all of which are guaranteed by the facility. We then update the plan on a regular basis as needs change, to ensure that appropriate care is always administered.

Though Medicare doesn’t typically cover costs associated with assisted living, the two work together as components critical to ensuring a happy and healthy life for the elderly.

Encore at Avalon Park features the following unique services to do just that:

• Oversight of physical well-being by Florida Hospital Neuroscience Institute and Florida Hospital physician team.
• Consistent monitoring of a resident’s physical and emotional well-being with a holistic approach encompassing nutrition and physical activity.
• Activities that correspond with a resident’s abilities and talents with an appropriate level of social interaction and stimulation.
• Comprehensive support and education program for families, including those dealing with advanced stages of Alzheimer’s.
• A visiting podiatrist and dermatologist.
• Physical and speech therapy.
• Skilled nursing, including 24 hour nursing services.

Call Encore Home

Choosing an assisted living facility for your loved ones can seem like a daunting task, but when you choose Encore at Avalon Park, you can rest assured knowing your loved one is receiving the absolute best assisted living care in the area. Our attentive staff, comprehensive care plans, and gorgeous facilities allow your loved ones to live their life to the fullest. For any questions about Medicare or our facilities, call us today at 407-270-7500.