Does Insurance Pay for Adult Foster Care in Oregon?

Adult foster care is care, usually nonmedical, provided in a single-family home to a small number of residents. Oregon inspects and licenses adult foster care homes, which may be called assisted living in other states. Adult foster care is for those who need more care than can be provided in their own home but who may not need or want nursing home care. Adult foster care may be covered by insurance, depending on the type of policy.

Medicare

• Adult foster homes focus on nonmedical care, also known as custodial care, which includes assistance with eating, bathing, dressing, grooming and continence, also called activities of daily living (ADLs). Medicare does not cover custodial care. Some adult foster care homes specialize in medical care, such as care for those with respiratory failure or brain injuries; medical services that would be covered by Medicare just as they would be in a hospital or doctor's office. Some adult foster care homes specialize in hospice care, which is also covered by Medicare.

Medicaid

• Medicaid may cover adult foster care, depending on the situation. Generally, Medicaid eligibility is determined by income and assets, but if your care bills are high and you don't have any other insurance that can cover them, you may qualify for Medicaid. For Medicaid to cover your care, you must be in a foster home that accepts Medicaid payments. To find out if you're eligible for Medicaid, contact your local Department of Human Services office.

Long-term Care Insurance

• Long-term care insurance may cover adult foster care as long as you meet the qualifications for benefits in the policy and your policy covers more than just nursing home care. Generally, long-term care policies pay benefits when you need help with two or more of your activities of daily living. There may also be a waiting period built into your policy and a daily, weekly or monthly maximum benefit. If you're unsure of your benefits or how to file a claim, contact your insurance company.

Private Pay

• If you don't have long-term care insurance and don't qualify for Medicaid, you may need to pay for adult foster home care out of pocket. Adult foster homes have a basic monthly rate, which should include room and board and laundry. Other services may be charged individually, like incontinence care, transportation, dementia care or assistance with eating. The costs should be clearly spelled out in a contract, which should also have the home's refund policy and how to terminate the contract if needed.