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Medicare and Assisted Living

The room, board, and personal/custodial care services provided in the assisted living setting are not covered by Medicare. Physician services, medication, lab work, health nursing and therapies continue to be covered by your Medicare or other health insurance policy.

Residents and their family are still in control of their medical care in that they may continue with primary and specialty physician appointments in the office setting. However, some assisted living facilities may offer their own in-house physician services.

This may be a very prudent choice for residents. In-house physician care can alleviate difficulties with outside scheduling and transportation. It is also a great option for those residents with dementia, as it eliminates waiting in a crowded physician office which may prove to be over-stimulating and stressful.

Medicare Coverage

Now that you have become involved in assisting with your parent's care, you are trying to figure out how their health insurance works. Your parent has Medicare. In your mom's wallet you find her red, white, and blue card. You don't know how it works but you know it seems to cover her well.

Most of us who have used insurance are used to commercial health insurance through our employer. Medicare coverage has different parts. Part A covers inpatient care such as hospital stays, rehab facilities, and some home care services.

Part B covers outpatient care such as testing and physician office visits. Part D covers prescriptions. What about C? Part C is Medicare Advantage or Medicare Replacement plan. It provides the same services as Parts A, B, and D under an umbrella plan.

Medicare Advantage

October 15th - Dec 7th is open enrollment for Medicare. This is a time for beneficiaries to make changes in the way they receive their Medicare services.

The most common change people make is to choose a Medicare Advantage plan. These plans look very much like some managed care commercial plans. These plans usually have some form of provider network with whom they contract. They are required to cover the same things that original Medicare covers, but may structure services differently.

Additionally, by managing their services, they often may offer lower rates to their members. Many times there will be no monthly premium and may offer $0 copays for office visits. Some offer services above and beyond what Medicare covers. While some do not, many Medicare Advantage plans also cover prescriptions under the same umbrella of care.

Some areas of the country offer more Medicare Advantage plans than others. It is important to review which plans service the county of your residence. Equally important is to consider your current costs and coverage. If you are happy with what you have, then you don't have to change a thing!

Reviewing Prescription Coverage

Medicare Part D is the type of policy that covers prescriptions under original Medicare. For those who have used a stand-alone policy in the last years, be advised, prices are going up. Premiums and deductibles may be noticeably higher this year. It pays to shop around.

Medicare consumers have until December 7th to make a change to their prescription coverage policy. One handy tool to do a comparison can be found on Medicare.gov website. On this website, a consumer can plug in their zip code and specific prescriptions and do a comparison.

The most important factors to compare are, cost of premium, cost of deductible, gaps in coverage (donut hole), and co-pays for generic versus brand name prescriptions.