Does Medicare Cover Assisted Living in North Carolina?

Medicare does not offer coverage for assisted living in North Carolina, leaving many beneficiaries to seek financial help elsewhere. Fortunately, there are a few options to consider. Social Security offers a program that provides tiered payments for specialized nursing home centers. For days 1 to 20, the program will pay the full cost of covered services, including a semi-private room, meals, medications, medical supplies, dietary counseling, and rehabilitation care.

For days 21 to 100, you'll need to pay a co-pay and Medicare will cover the rest. After the 100th day, your Medicare coverage will no longer apply and you'll be forced to pay the full cost of the services. In North Carolina, Medicaid won't pay for room, board, or meals, but it will cover personal care services for up to 80 hours a month if prescribed by a doctor. The resident must already be a Medicaid beneficiary and be able to demonstrate that they need help with tasks such as bathing, dressing or eating.

Assisted living facilities are considered a “residential environment” and not a “clinical setting” (think nursing homes). While Medicare doesn't cover the cost of care received in an assisted living community, it does cover things like approved medications, doctor visits, medical equipment, and so on. Planning ahead could help you assess the costs of assisted living and make informed decisions based on your needs. Because COVID-19 is a rapidly evolving crisis, be sure to contact your assisted living center or local senior agency for the most up-to-date information.

Assisted living homes must provide 24-hour staff and resident supervision and organize transportation, personal care, activities, and cleaning service. The most expensive areas for home care don't always align with those that are most expensive for assisted living. Assisted living typically provides custodial and supervisory care but not the type of medical treatment normally found in a nursing home. In addition to providing medical care, staff members can help with 26% requests for assistance and other benefits relevant to older people who need assisted living.

There are several ways to make assisted living more affordable. Some states only pay for assisted living through Medicaid exemptions, meaning that people who qualify are on a waiting list. The benefit is intended for veterans who need long-term care services and can be used to pay for assisted living. Personal Care Services (PCS) is another option that covers a variety of personal care services provided at home or in a residential setting such as an assisted living center.

North Carolina has 16 regional agencies on aging that help older people who need assisted living or are interested in community alternatives. Some plans will only cover nursing home care and others will cover everything from assisted living facilities to in-home care.