Columbia Senior AdvisorWill Medicare pay for assisted living in Columbia?
No. Medicare pays nothing toward rent, meals or personal care in a CRCF or any assisted living setting; it pays only for covered medical services a resident receives there, such as doctor visits, home health and hospice.
This is the misunderstanding we hear most often on first calls. Assisted living in South Carolina is paid privately, with long-term care insurance or VA pension, or, for people with low income, through Optional State Supplementation or Community Choices Residential Personal Care in participating CRCFs.
How long does Medicare cover a nursing home stay?
Medicare Part A covers up to 100 days of skilled nursing facility care per benefit period after an inpatient hospital stay of at least three days: days 1 to 20 at no cost and days 21 to 100 with a daily coinsurance, as long as daily skilled care is still needed.
The three days must be as an admitted inpatient. Time under observation status does not count, and that distinction catches Columbia families every week. Ask the hospital in writing whether your parent is admitted or under observation. Medicare Advantage plans may waive the three-day rule but usually require prior authorization and use their own network of nursing homes.
Does Medicare pay for home health care?
Yes, when a doctor certifies that the patient is homebound and needs intermittent skilled nursing or therapy; Medicare then pays a certified home health agency for those visits, plus part-time aide help tied to the plan, at no charge to the patient.
DPH lists 17 home health agencies, 18 hospice programs, 1 inpatient hospice house and 290 in-home care providers with offices in the six Midlands counties. Medicare does not pay for hourly companions, homemakers or round-the-clock aides. That help comes from licensed in-home care agencies, paid privately, through long-term care insurance, VA benefits or Community Choices.
Does Medicare cover hospice for someone in a Midlands CRCF or nursing home?
Yes. The Medicare hospice benefit covers the hospice team, medications and equipment for the terminal illness wherever the patient lives, including a CRCF or nursing home, when a physician certifies a life expectancy of six months or less if the illness runs its usual course.
It does not pay the facility's room and board. Short inpatient stays for symptom control and respite are covered at a hospice inpatient unit or contracted facility; the Midlands' licensed inpatient hospice house is in Lexington. DPH's data shows 18 licensed hospice programs with Midlands offices and 1 inpatient hospice house: Lexington Community Hospice House (Lexington, 30 beds).
Where can Midlands seniors get free Medicare counseling?
From South Carolina's State Health Insurance Assistance Program (SHIP), offered through the regional Area Agencies on Aging: Central Midlands Council of Governments ((803) 376-5390) for Richland, Lexington and Fairfield counties, and the Santee-Lynches, Lower Savannah and Upper Savannah agencies for Kershaw, Calhoun and Saluda.
Counselors explain Original Medicare and Medicare Advantage, Part D drug plans, Medigap, and help programs such as the Medicare Savings Programs and Extra Help, and they sell nothing. Medicare's annual open enrollment runs October 15 to December 7.
Side by side
| Medicare pays for | Medicare does not pay for | |
|---|---|---|
| Nursing homes | Up to 100 skilled days after a 3-day inpatient stay | Long-term custodial nursing home care |
| Assisted living | Medical services delivered there | Rent, meals or personal care |
| At home | Skilled home health for homebound patients | Hourly aides or companions |
| End of life | Hospice team, drugs and equipment | Room and board in a facility |
Drawn from S.C. Code Regs. 60-84, DPH Healthcare Quality and SCDHHS publications, CareScout, CMS, the VA and the regional aging agencies cited in the text; our editorial standards explain how we check them.
