Medicare, Medicaid and Home Care

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. At the same time, family members are often stretched too thin to provide all the help someone living with 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 it be paid for so that people can be helped? The help needed is often non-medical home health care such as transportation, meal preparation, respite for family caregivers and other activities of daily living.

Medicaid

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 on this method of payment by state on their website. However, Medicaid is not traditionally a reliable method of paying for in-home care services which can help people with their activities of daily living such as safely grooming and bathing, meal preparation, running errands and the like.

Medicare

The ability to use Medicare to pay for in-home care services is evolving. Medicare is the federal health insurance program for people who are over age 65 (as well as some people who are younger living with certain disabilities) and it has three parts: A, B, 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 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. 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.

Availability of expanded services covered under Medicare Advantage plans will depend on the state and county and also the insurance provider. Insurance plans may require documentation of medical need to cover things such 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 here is that these government payor sources are increasingly recognizing the need for non-medical home services and finding ways for people to access them and pay for them.

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

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