To determine if there are any health insurances that cover a portion of the senior living model.
To determine if there are any documented cases of "social wellness coverage".
Our research on senior living and health insurance coverage revealed insights. Here are key pieces of information we found:
Senior Living and Health Insurance Coverage
- Health insurance does cover the portion of the senior living model that pertains to assisted living, nursing homes, and living at home, with certain restrictions.
- For example, Medicare does not pay for home care or assisted living and does not pay for home modifications of any kind. (One exception is that some Medicare Advantage plans may now offer in-home personal care) Medicare does cover nursing homes but does not cover nursing homes at 100% and only pays for a limited period of time. From day 1 to day 20, Medicare covers 100% of the cost, from day 20 to day 100, it covers 80% of the cost, and after day 100, Medicare pays nothing.
- Medicaid, unlike Medicare, offers significant coverage that will pay for unlimited nursing home care, and through each state's HCBS waivers, Medicaid usually pays for some home care and assisted living.
- People may choose to supplement their health insurance coverage with long-term care insurance.
- Depending on the policy options selected, long-term care insurance can help pay for senior living options at home, in an assisted living facility, or a nursing home. Some policies will even help pay costs associated with modifying a senior's home in order to keep living in it safely.
- Despite validating the importance of social wellness for senior living, there appears to be no social wellness coverage from information that is publicly available.
Proposed next steps:
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We recommend additional research to provide 5-7 insights about how health insurance coverage impacts senior living choices to also include any publicly available statistics on the number of baby boomers in the US who have medicare, medicaid, and long-term care insurance.
We also recommend additional research to provide 5-7 more insights on the social wellness element and how this element is being discussed and implemented in the current senior living model.