If you agree there’s no place like home, then you’re not alone. As a matter of fact, AARP reports that almost ninety percent of seniors prefer to maintain their present living conditions as they age. And while that may be fine for now, everyone’s circumstances can and likely will change.
Whether it’s carrying groceries up the stairs, making trips to the doctor or pharmacy, or even getting in and out of the bathtub – each may become more difficult over time. That’s why it’s important to know what Medicare will and won’t cover when it comes to in-home care. This will enable you to choose the best health plan for maintaining your well-being and your independence in the months and years ahead.
Does Medicare Cover Home Health Care?
Original Medicare consists of Part A (Hospital Insurance) and Part B (Medical Insurance). Original Medicare will cover in-home health services under specific circumstances when eligibility criteria have been met.
These Original Medicare services include physical therapy, occupational therapy, speech-language pathology services, and part-time or intermittent skilled nursing care/home health aide services. Your doctor must deem these services are medically necessary and certify that you are homebound.
Original Medicare does not cover services to assist you with your home or personal care if these are the only services you need. Thankfully Medicare Part C, also known as Medicare Advantage, has plans that will.
Medicare Home Care Benefits
Medicare Advantage (Part C) is offered by private insurance companies approved by Medicare. Medicare Advantage bundles together Medicare Parts A and B and offers a variety of additional benefits, such as vision, dental, and more.
Starting in 2019, the Centers for Medicare & Medicaid Services (CMS) authorized Medicare Advantage providers to begin offering non-skilled in-home care. This exciting development means key services seniors need in order to continue living healthfully at their homes are now covered by many Medicare Advantage programs.
These benefits include:
- Help with daily personal care, such as bathing, grooming, and getting dressed.
- Aid with keeping track of medications (management and consumption).
- Assistance with catheters or colostomy bags.
- Guidance on how to make healthy meals and help with eating.
- Transportation to physicians’ appointments.
- Certain forms of housecleaning for those who have a condition such as asthma.
What’s more, selected services may be offered by either a professional caregiver or a relative of the insured’s choosing. (Note: there is a cap on the total hours allowable each year.)
While these Medicare in-home care benefits may be obtained without a prescription, they have to be deemed medically appropriate by a licensed healthcare professional.
In addition to helping seniors with daily chores, Medicare Advantage benefits may also include coverage of key devices and the installation of safety equipment in the home. These can range from shower stools, raised toilet seats, and grab bars and rails, to wheelchair ramps.
Certain exceptions will apply, for example, smoke detectors are not covered. So be sure to check the specifics of the policy to know what is included.
Another valuable benefit that select Medicare Advantage plans provide is respite care coverage. There are three variations available, let’s take a closer look at each:
- Short-Term Stay at Nursing Home or Assisted Living Facility – Sometimes seniors will find themselves in situations where returning home right away is not feasible. Say a fall has led to a leg fracture, making stairs impassable for the near future. Or perhaps a trusted caretaker has been temporarily called away.
In each of these cases, having a safe and reliable place to go for a brief time makes a huge difference. Senior living facilities will often have a selection of short-term stay rooms set aside for just this purpose.
- In-Home Respite Care – For some seniors, the best option is to keep them in their own homes. Depending upon the plan, it may be possible to have a professional come in and provide the main caregiver some much-needed time away.
- Adult Day Care – This type of facility offers the added benefit of social interactions. This enables seniors to meet and communicate with others and ultimately feel more connected to the community. These facilities also offer peace of mind because the staff is ready and able to address any health needs that may arise.
Why Medicare In Home Care Matters
So why did the Centers for Medicare & Medicaid Services (CMS) authorize Medicare Advantage providers to expand their benefits? Because helping seniors to stay in their homes has a huge impact on their mental, physical, and financial well-being.
Consider the sense of independence and empowerment provided by having control of your environment. It’s your space, you decide what you want to do and how you want to do it. There’s also comfort in familiarity. You know your home and how to navigate it. In addition, you appreciate the history and stories behind all the items you have put in your space.
If you’re able to venture into the community, you know all your regular haunts and where to go for each of the things you want. Whether it’s a quick shopping trip to pick up essentials or a cup of coffee at your favorite diner where familiar friends gather. Keeping these connections alive will help you thrive.
Financially, the cost of staying in one’s home can be significantly cheaper than moving into a senior living facility. According to the U.S. Department of Housing and Urban Development, twenty percent of seniors have paid off their mortgages entirely, making housing expenses even less. For other seniors, there are programs in place to enable them to leverage the equity in their homes.
As you’re evaluating the many Medicare options available to you, keep this thought in mind. There’s a significant difference between Medicare home health care and Medicare in-home care. One is there for health emergencies, while the other could help you stay in the home you love for many more years to come.