Does Medicare Cover Home Care

April 6, 2018 0

Medicare provides valuable coverage for medical expenses for the elderly population, but does Medicare pay for home care?

In today’s post, we will find out what home based services will Medicare pay for, and which ones are not covered. We will also explore ways to pay for your home care that reduces financial strain on you and your family.

Sometimes people use the terms home care and home health care interchangeably. They indeed complement each other. They are different services and Medicare treats them as such.

The long and short of it : Medicare pays for health care costs that are associated with a doctor’s diagnosis and prescriptions. Medicare does not cover home care services. Medicare does not consider home care services part of medical care.

While both Home Care and Home Health Care are home-based, Home Health provides medical services whereas Home Care does not.

Home Care services include :

  • Light housekeeping
  • Transportation
  • Errands
  • Personal Care
  • Meal Preparation
  • Medication reminders
  • Companionship for appointments
  • Phone support
  • Care for bed bound individuals
  • Assistance with walking and transfers

As you can see from this list, home care focuses on services that support daily living needs.

Home Health services include :

  • Intermittent skilled nursing care
  • Speech pathology services
  • Physical therapy
  • Occupational therapy

Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable drugs.

Typically, a home health care agency will coordinate these services based on a doctor’s orders/prescriptions. Medicare only covers services provided by a Medicare-certified agency. It would also mean that you saw a doctor or nurse practitioner face to face for your diagnosis and they certified that you are homebound.

It is important to note that your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you will have to pay some or all of the costs.

Ask questions so you understand why your doctor is recommending certain services, whether Medicare will pay for them and even if they are absolutely necessary.

This document which was prepared by the government will give you and even deeper look into how Medicare works for your home health care.

If Medicare does not cover my non-medical home care costs, how can I afford to have home care ?

Here are the main ways you can pay for home care services.

Private pay:

This is where you or your loved ones pay for home care out of pocket. While you can get significant assistance from some the programs we are going to list below, it is very likely that if you intend to work with a home care agency, you will pay all or part of your costs out-of-pocket. It is important to think of this so you can plan for it as much as possible.

Long term care insurance :

If you have long term care insurance, your policy may cover some or all of your home care cost.

State/local government assistance :

Your state or local government may have assistance programs for seniors or individuals who are homebound. A quick search online or a phone call to your state’s health department will help you find those details.

In the state of California for instance, the Family Caregiver Support Program which is administered by the California Department of Aging provides educational material, assistance with gaining access to services, counseling, temporary respite and limited supplemental services to help family caregivers.

There is no income requirement for the Family Caregiver Support Program.

The following requirements need to be met as well :

  1. Family caregivers of older adults must be 18 years of age or older.
  2. Care recipients must be:
  • Age 60 years or older, or individuals of any age with Alzheimer’s disease or related disorder with neurologic and organic brain dysfunction.

You can learn more about this program for Californians by calling 1-800-510-2020.

Veteran eligible for VA Pension :

If you are a veteran who is eligible, VA Aide and Attendence may cover some of your home care costs. To qualify, a physician must diagnose you 50% disabled and you have to be over 65 years old to get home care financial assistance. Get in touch with your local VA to find out more about your benefits as a senior veteran.

Medicaid benefit for low income seniors :

In some cases, if you or your loved one is on Medicaid, there are Medicaid waivers that will pay for a limited number of hours for home care services per month. It is worth checking with your Medicaid representative to see if this benefit is available to you.

Closing Thoughts

While Medicare does not cover home care costs, other programs may offer home care benefits. In this post, we have shared alternate ways for you to explore when it comes to paying for home care costs.

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