How to Get Medicare & Medicaid for a Senior Citizen's Assisted Living

Medicare is federal health insurance for the elderly and certain disabled individuals. Medicaid is a state-administered health insurance program for certain low-income individuals, including the elderly, the disabled, pregnant women, and children. Original Medicare covers qualifying medical services received while residing at an assisted living facility, but will not cover room and board, daily living costs, activities and many caregiver tasks. Medicaid typically covers the expenses not covered by Medicare at assisted living facilities.

Instructions

• 1

  Contact your state Medicaid office to enroll. Your resources may exceed the limit for Medicaid eligibility. You may need to cash out all of your resources (i.e. checking and savings accounts, bonds, retirement plans, etc) and use this income to pay for assisted living expenses until your resources are "spent down" to the point where you are below the resource limit and are eligible for Medicaid.

• 2

  Contact your state Medicaid office to inquire about your eligibility for Qualified Medicare Beneficiary (QMB) benefits. QMB pays your Original Medicare premiums, co-insurance payments and deductibles and is available to individuals who are eligible for both Medicare and Medicaid.

• 3

  Ask your primary care physician to compose a letter stating the medical necessity for assisted living services. This letter should include specific medical diagnoses that affect your ability to care for yourself. Medicare and Medicaid both typically require documentation of medical necessity prior to approving payment for a assisted living facility. Contact 1-800-MEDICARE and your state Medicaid office to discover any other documentation that must be completed and submitted prior to being approved for assisted living services.

• 4

  Contact 1-800-MEDICARE and your state Medicaid office to obtain a list of approved assisted living facilities. You must select an assisted living facility that accepts Medicaid and Medicare as payment, or you will likely be held responsible for the full bill. The cost of residing at an assisted living facility averages about $1,800 per month in the United States.

• 5

  Contact an approved assisted living facility and schedule an appointment to be assessed for services. Notify the facility that you receive Medicaid and Medicare benefits.