What Medicare does and doesn't pay
Medicare.gov says Medicare doesn't pay for long-term care, the non-medical help with daily activities that people get at home, in assisted living or in a nursing home. In a Florida ALF that means Medicare won't pay:
- Rent, meals or housekeeping.
- Personal care, such as help with bathing, dressing, eating or taking medications.
Your Medicare keeps working while you live in an ALF: Part B for doctor visits, lab work and equipment, Part A for hospital stays and short skilled nursing stays, and Part D or your Medicare Advantage plan for prescriptions. Medigap doesn't pay for long-term care either.
Florida Medicaid's Long-Term Care program
Florida Medicaid's Statewide Medicaid Managed Care Long-Term Care (LTC) program can pay for assisted living services. AHCA describes them as services usually provided in an ALF, such as housekeeping, help with bathing, dressing and eating, medication assistance and social programs. To qualify you must be 65 or older (or 18 or older with a disability), meet Medicaid's financial rules set by the Department of Children and Families (DCF), and need nursing-home level of care as decided by the state's CARES program.
Florida has a wait list. Home and community-based LTC services, including assisted living, are released from a statewide list ranked by a frailty-based priority score (s. 409.979). Ask the ALF and the LTC plan what you'd still pay yourself, including room and board.
See Florida Medicaid long-term care for the screening and enrollment steps.
Optional State Supplementation
Florida's Optional State Supplementation (OSS), in s. 409.212, Florida Statutes, makes a monthly payment toward the cost of care for people who receive SSI or are found eligible by DCF and who meet the requirements for an ALF, adult family-care home or similar setting. Family or others can add voluntary payments made directly to the facility, within limits the law sets. Apply through DCF.
Checking an ALF
AHCA licenses Florida ALFs. You can look up a facility's license and inspection information on AHCA's FloridaHealthFinder site before you sign a contract. To talk through how your Medicare plan works while you live in an ALF, you can request a call from a licensed insurance agent.
Related questions
Does Medicare cover nursing home care in Florida?
The 100-day skilled nursing benefit and Medicaid.
Does Medicare cover home health care in Florida?
Skilled care at home for homebound patients.
How do I get rides to the doctor with Medicare in Florida?
Ambulance rules and other ride options.
Sources
- Medicare.gov — Long-term care
- Florida Statutes — s. 429.02, Definitions (assisted living facility)
- AHCA — Find Out About Long-Term Care Services
- AHCA — Who Can Receive Long-Term Care Services
- Florida Statutes — s. 409.979, Long-term care eligibility and wait list
- Florida Statutes — s. 409.212, Optional supplementation
- AHCA — FloridaHealthFinder
More questions in this guide
- Does Medicare cover me if I travel to Cuba, Latin America or the Caribbean?
- Does Medicare cover dental in Florida?
- Does Medicare cover home health care in Florida?
- Does Medicare cover nursing home care in Florida?
- How do I get rides to the doctor with Medicare in Florida?
Part of the guide: Medicare basics for Floridians · All questions
Frequently asked questions
What is an assisted living facility in Florida?
Florida law (s. 429.02) defines an ALF as a residential facility that provides housing, meals and one or more personal services, such as help with bathing, dressing or medications, for more than 24 hours. ALFs are licensed by the Agency for Health Care Administration (AHCA). Personal services don't include medical or nursing care.
Does Medicare Advantage pay for assisted living?
Medicare Advantage plans cover what Original Medicare covers and may add extra benefits, which vary by plan. Long-term care in an ALF isn't a Medicare benefit, so check a plan's Evidence of Coverage before counting on anything. A FIDE-SNP, available to some people with full Medicaid, also carries their Medicaid long-term care.
What is Optional State Supplementation (OSS)?
OSS is a Florida monthly payment under s. 409.212 for people who get SSI or are found eligible by the Department of Children and Families and who meet the requirements to live in an ALF, adult family-care home or similar setting. It helps pay for their care there.
Medicare in your Florida county
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