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How Does Blue Cross Blue Shield Approach Assisted Living Coverage?
Date Updated: July 26, 2024
Written by:
Tiffany Amber Stockton, an award-winning author and speaker, excels in crafting narratives on senior healthcare, with an expertise in memory care after helping her grandfather live with dementia. With twenty-six published books to her credit, she uniquely blends literary prowess with a compassionate understanding of the challenges faced by older adults. Follow her on LinkedIn for updates on her distinguished writing career in the realm of professional copywriting and copyediting.
Reviewed by:
Gene Altaffer has a Masters in Gerontology from the University of Southern California and has worked in many avenues along the continuum of long-term care, assisting thousands of clients and their families since 1995. He also sold long-term care insurance from numerous carriers while also assisting families with retirement planning. Gene helps seniors navigate their Medicare plans, ensuring they understand their benefits and options.
Blue Cross Blue Shield approaches assisted living coverage by offering exceptions to standard coverage when required medical care exists. BCBS offers Medicare Advantage, Medigap and standalone Medicare Part D plans. These policies rarely cover assisted living or other types of long-term care, but some coverage may exist through specialized plans and long-term care insurance. Contact your preferred BCBS insurance company to discuss available options for your specific needs.
Considerations for Blue Cross Blue Shield assisted living coverage
BCBS operates as a group of independent health insurance companies under the Blue Cross Blue Shield Association, so coverage for assisted living services varies among individual companies. Some state regulations require and make available specific types of coverage, while others let the insurance companies decide. If a health care professional deems assisted living medically necessary, it may increase the likelihood of coverage. This includes administering medication and providing routine assistance with ADLs.
Documenting medical necessity for assisted living coverage
To secure coverage through a BCBS insurance company, you’ll need a health care professional to deem your assisted living services as medically necessary. Provide detailed medical records, including any chronic conditions, disabilities or diagnoses that impact your ability to perform ADLs independently. Clearly document functional limitations, emphasizing any challenges in mobility or prescribed treatment plans that necessitate the level of support provided in an assisted living setting.
Clearly articulate the need for assisted living over other care settings, and ensure consistency in all documentation. Once you have obtained the certification in writing, reach out to BCBS, and use the search tool to shop for insurance and see which plans are available in your area. BCBS coverage varies by state, so the application process differs for each individual. You will be able to enroll online or by phone with a licensed agent.