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Medicare, Medicaid, and Home Care

Here’s the situation: People are living longer, but not always healthier and therefore may need more assistance as they age. The support needed is often non-medical home health care such as transportation, meal preparation, respite for family caregivers, and activities of daily living (ADLs), like bathing and dressing.

At the same time, family members are often stretched too thin to provide all the help someone living with advanced age or a chronic condition may require.

So, if more people need more care and in-home care is not covered under traditional health insurance, how can people afford to get the help they need?

Medicaid and Home Care

Millions of people rely on Medicaid, which is a federal and state program that provides access to healthcare resources for people who qualify based on their income level. People of all ages (not just those over age 65) can qualify for Medicaid.

The opportunity to use Medicaid to pay for in-home care will depend first on meeting the qualifications and then the state in which the person needing care resides. The National Care Planning Council provides some information about this method of payment by state on its website.

Some people who receive Medicaid are eligible for self-directed care coverage. This program allows the person to choose their own caregiver.

With that said, Medicaid is not traditionally a reliable method of paying for in-home care services.

Home Care for Seniors on Medicare

The ability to use Medicare to pay for family home care services is evolving. Medicare is the federal health insurance program for people over age 65, as well as some who are younger and living with certain disabilities. Medicare has three parts: A, B, and D, as well as Medicare Advantage (sometimes called Part C, or the “all in one”). Each part covers specific services such as hospital stays and prescription drugs.

According to the Department of Health & Human Services:

“Medicare Advantage Plans, sometimes called Part C or MA plans, are offered by private [health insurance] companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits.”

As of 2019, a small percentage of Medicare Advantage plans will offer non-medical in-home care support services to help people with ADLs. Given recent legislation designed to offer more benefits to individuals living with chronic conditions such as heart disease and COPD, experts anticipate the number of plans that will cover these costs to expand over the coming years, but there are no specifics available.

Related Content: What Are ADLs and IADLs?

Availability of expanded services covered under Medicare Advantage plans will depend on the policyholder’s state, county, and insurance provider. Insurance plans may require documentation of medical need to cover things such as a set number of hours of “personal care” or transportation for a set number of trips to a health-related appointment.

While the complexity of these plans can be overwhelming and even off-putting, the good news is that these government payor sources are increasingly recognizing the need for non-medical home services and finding ways for people to pay for them.

Learn about other ways to pay for in-home care.

Does Medicare Pay for Home Health Care by a Family Member?

Medicare does not compensate family caregivers directly. Medicare will only pay for care provided through a home health agency. And that’s where Homewatch CareGivers can help.

Homewatch CareGivers can onboard existing family caregivers as employees, enabling them to receive compensation for their efforts from Medicare. Our Family Caring for Family service is a simple solution for family caregivers who need and deserve to be paid for the support they provide to a loved one.

If you’d like to learn more and apply for our Family Caring for Family service, schedule an interview by clicking the button HERE.

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