There are over 62 million Americans currently enrolled in the federal social insurance program known as Medicare. Most Medicare recipients eventually need in-home assistance to perform activities of daily living (ADLs), like cooking, bathing, and toileting. When that time comes, families are often faced with tough budgeting decisions while paying for elder home care — including any Medicare benefits that may apply.
But does traditional Medicare pay for in-home senior care services? The answer to that question may surprise you.
Original Medicare Coverage is Limited
Original Medicare (Part A and Part B) does cover some limited home health services if and only if they are provided through a Medicare-certified home healthcare agency.
Some of the eligible home health services that Original Medicare may cover include:
- Part-time skilled nursing care
- Part-time home health aide care
- Wound dressing changes
- IV medications
- Medical social services
- Physical and occupational therapy
- Speech-language pathology services
Home healthcare benefits are available through Original Medicare only when determined to be medically necessary by your doctor. A Medicare-certified home healthcare agency can help you coordinate those “skilled” nursing care services.
Does Medicare Pay for Other In-Home Care Services?
On the other hand, Original Medicare does not typically cover:
- Homemaker services
- Meal delivery services
- 24-hour care received at home
- Custodial care (eating, personal hygiene, toileting, etc.)
When an aging loved one needs non-medical assistance at home, many families end up paying for those services either out of pocket, with long-term care (LTC) insurance, V.A. benefits, or some other means.
Paying out-of-pocket for home care services can be a financial “game-changer” for some families. For example, the median monthly cost of homemaker services is $4,481, a figure expected to rise dramatically over the next decade. The monthly cost of 24-hour in-home care in a state like California could be four to five times that amount!
Where Medicare Advantage Comes In
Often referred to as Medicare Part C, Medicare Advantage (MA) supplemental plans combine the benefits covered by Medicare Part A and Part B into one plan sold by a private insurance company. Medicare Advantage plans cover the same home health care services that are covered by Medicare Part A and Part B.
However, in addition to those services, many MA plans offer an expanded list of benefits for seniors that may include:
- Prescription drug coverage
- Dental care
- In-home caregiver support services
- Home health aides to assist with daily activities like eating, dressing, or bathing
- Homemaker services
Depending on the insurance carrier, some supplemental Medicare Part C plans even cover healthier food options, transportation to and from doctor’s appointments, air conditioners for people with asthma, home-delivered meals, and grab bars for bathrooms.
Making Healthcare More Affordable for All
Back in 2018, the Centers for Medicare and Medicaid Services (CMS) approved new Medicare Advantage guidelines – on a trial basis – that allowed private insurance carriers to expand coverage and help pay for in-home care. If the current MA trials are successful, the federal government could likely adopt home care coverage into Original Medicare (Part A and Part B) plans.
As a result, home care services would probably become more affordable for all Medicare recipients. Better yet, it could reduce healthcare costs for people of all ages, including those aged 65+.
How to Choose a Home Care Provider
Once enrolled in a Medicare Advantage plan, you can then start looking for a licensed home care provider in your area that can deliver the services you need.
Here’s how to narrow down your search list:
- What do others say about them?
- What accreditations and certifications do they have?
- Do they provide ongoing staff training?
- Do they thoroughly screen their caregivers?
- What’s their emergency backup plan?
An Extended Family in Your Loved One’s Home
Finding the right caregiver for your aging loved one can be frustrating. At New Wave Home Care, we’ve been helping families in Southern California keep aging loved ones safe and comfortable in their own homes for 10+ years now. As a licensed home care provider, we support clients and their families with personalized in-home solutions that include companionship care, personal care, transitional care, respite care, dementia and Alzheimer’s care, and hospice support.
When you choose New Wave Home Care in Pasadena, you can rest assured that your loved one is getting the specialized care they need from a trusted, friendly caregiver. To learn more now or schedule a FREE in-home assessment for a senior in the greater Los Angeles area, please visit us at www.newwavehomecare.com.
