Does Medicare cover assisted living in North Carolina?

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This is a question that many Medicare beneficiaries ask themselves when they are deciding what to do with their finances. There are many factors to consider, including Medicare coverage and the cost of assisted living in North Carolina.

In this article, we will discuss how Medicare works for beneficiaries and show you how much Medicare covers as well as any special requirements for receiving assisted living in North Carolina.

How much does assisted living cost in North Carolina?

Assisted living anywhere in the United States is nothing short of expensive. According to a survey done by, the national average for assisted living costs is an astounding $4300 each month.

North Carolina is slightly under that monthly cost, coming in at $3800 per month. This cost can vary greatly across the state. Lower costs, around $2700 per month, are found in cities like Burlington, Jacksonville, and Asheville. Areas around Goldsboro, Fayetteville, and New Bern come in around $3500. Assisted living costs in North Carolina occur in Greensboro, Raleigh, Winston, and Charlotte. Costs in these areas can be up to $4800 per month, higher than the national average. The highest cost of assisted living in North Carolina is nearly $5900 per month in the city of Wilmington.

Costs can increase if there is a need for additional supervision, like for those individuals with Alzheimer’s. These residents will pay an extra $950 each month.

What assisted living benefits does Medicare cover?

Medicare is a program created by the federal government to assist adults age 65 or older with their healthcare needs. It’s also available to younger adults who have been receiving disability benefits for two years and for individuals with specific conditions like End-Stage Renal Disease.

There are four parts to the program, and it’s important to know what is involved in each part in order to know if you have coverage for assisted living. We won’t get into too much detail here, but let’s review the basics.

Part A

Part A provides coverage for inpatient hospital services. Think of it as your “room and board” for hospital stays. It will also cover skilled nursing facility care, hospice care, and home health care.
Most Medicare beneficiaries do not pay a premium for Medicare Part A.

Part B

Part B provides coverage for outpatient services. It will cover doctor visits, lab tests, some preventive services, durable medical equipment (DME), and ambulatory transportation. Medicare beneficiaries will pay a premium for Medicare Part B. In 2021, this premium is $148.50.

Together, Parts A and B make up Original Medicare. Neither Part A nor Part B offers benefits for assisted living.

Part C

Part C is more often referred to as Medicare Advantage or MA for short. Medicare beneficiaries can choose to enroll in a Part C plan offered by private insurance companies. These companies have been approved by the Medicare program to offer coverage to Medicare enrollees.

Part C bundles all the coverage offered in Parts A and B and often has many additional benefits like those for dental, vision, and hearing services and prescription drug coverage.
Medicare Advantage policyholders may also find a plan with long-term care benefits, including personal care assistance for those who live in assisted living or memory care facilities. However, this does not include the room and board costs associated with the care facility.

These plans will vary by carrier and location.

Part D

Part D is where all prescription drug coverage lies. Sometimes this can be bundled into a Medicare Advantage plan, called an MAPD plan. Otherwise, a Part D plan can usually be purchased separately from a private insurance company. Like Medicare Advantage plans, coverage varies by carrier and location.

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Medicare Supplements

Medicare supplements are also referred to as Medigap plans. Medicare beneficiaries who choose not to enroll in Part C often choose a Medigap plan to pay for the “gaps” in Original Medicare.

However, Medigap plans will not cover any services not also covered by Original Medicare. Since Original Medicare does not pay for assisted living, neither will a Medigap plan.

To sum it up, Medicare offers its beneficiaries no coverage for assisted living.

Are there any special requirements for receiving assisted living in North Carolina?

There are general requirements that all states follow when assessing an individual for admission.

The individual must meet the following requirements.

● Need help with daily living tasks – eating, grooming, using the restroom, dressing, and household chores.
● Must be able to walk or be able to move around independently with the assistance of a walker, cane, or wheelchair.
● Must not need around-the-clock care
● Must have a stable health condition.

Individuals that require more attention and medical care will not qualify for assisted living. These individuals will likely need to seek admission to a nursing home. If an individual has severe mental health disorders or has proven to be a danger to themselves or others, they will also not qualify.

Lastly, the individual applying for admission must be able to comprehend and sign a contract of their own accord.

How can I get financial assistance for assisted living?

Since Medicare offers no benefits for assisted living and the cost of care is so high, many beneficiaries are left looking for financial assistance elsewhere. Fortunately, there are some options to consider.

Special Assistance Program

This program is offered by Social Security. Those who are considered to have low income may qualify for financial assistance through this program. Half of the program is funded by the state of North Carolina, and the other half is funded by the state’s counties.

If an individual is accepted into the Special Assistance Program, they will also qualify for Medicaid benefits.

Other Options

Below, you’ll find a list of other options that may be of assistance. Eligibility will vary, so you will need to see if you meet the requirements of each.

● Ombudsman Program for Long-Term care
● Area Agencies on Aging
● Life insurance policies
● Long-term care insurance policies
● Veterans benefits
● Reverse mortgages

While the cost of assisted living is slightly lower than average in North Carolina, it is still difficult for the majority of individuals to afford it. It may seem far into the future for some, but it’s important to begin planning for these expenses early.

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