Medicare Can Help You Delay an Assisted Living Placement

Tis the season of Medicare Open Enrollment.  Between 15 October and 7 December of this year you can change your Medicare health or prescription drug plan for 2019. Any change to your Medicare plan will become effective 1 January 2019.  Among many reasons why you might want to research new plans is a change in your health status, to find a lower priced plan, or because you want to stay at home rather than moving into assisted living.

CARR has long advocated for individuals or families to consider all options before moving yourself or a family member into assisted living.  Lower-cost alternatives (in-home supportive services, housekeeping, delivered meals, adult day care, or home health services) offer you more control of your lifestyle and living environment, and can keep you in your community, among friends and social activities, longer. If you are looking for lower-cost alternatives to assisted living, or are wanting to delay relocating to an assisted living environment, it might be time for you to consider your options during this Medicare Open Enrollment period. 

The following services are offered with Original Medicare, under Part B, as well as with any Medicare Advantage Plan.  These ‘preventative services,’ may help keep you or your family member living independently for longer. 

  • The home health services benefit includes bringing in health care professionals to take care of your medical needs such as physical therapy, speech-language services, occupational therapy, and part-time or intermittent skilled nursing care. This benefit can also include medical social services and part-time or intermittent home health aide services.  

For some of these benefits, you will need to be assessed by a doctor and you must be homebound.  The plan is adaptable to your specific needs, requires your doctor to write a plan of care, and allows for services to be delivered periodically or for a specific period of time. 

  • Advance care planning is an overlooked Medicare benefit and one you should consider if you don’t already have an advance directive.  An advance directive is a written document that records your wishes about medical treatment and related matters when you are unable to speak for yourself.  If you take advantage of this benefit during the yearly wellness visit to your doctor, you will likely pay nothing for this service.  
  • The right piece of durable medical equipment(DME) may keep you in your home longer. Sometimes the safe solution to increasing mobility and making your life easier in your home is simply having the right piece of equipment:  a cane, walker, wheelchair or oxygen equipment and supplies.  With a doctor’s order, a bath-lift or an elevated toilet seat may also be considered DME. If so, they would be covered under Medicare’s Part B. 
  • For those 9-1-1 events that happen at home, Medicare covers ground ambulance transportation.

For some of these benefits you may have a co-pay and/or an out-of-pocket expense that goes toward your annual plan’s deductible.  Considering that assisted living in California can cost upwards of $4,000 a month, finding the right mix of services offered under your Medicare plan may save you money and may allow you to live longer, independently.  Both are wins for you and your family.

If you have questions about Medicare coverage and plan options, how to enroll in Medicare or how to change plans, please call our friends at the San Diego HICAP office at 858-564-8772.  They are a group of trained and knowledgeable volunteers who can give you answers.  And, best of all, their assistance is free. 


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