.png)
By: Crystal Manning Licensed Medicare Advisor
Medicare pays for caregivers. However, beneficiaries must meet certain qualifications to be eligible for in-home medical care coverage. As of now, if it is deemed medically necessary for a beneficiary, they can use Medicare home health benefits for:
Part-Time (Intermittent) Skilled Nursing Care
Physical Therapy
Occupational Therapy
Speech-Language Pathology Services
Medical Social Services
Injectable Osteoporosis Drugs for Women
For beneficiaries to receive coverage for in-home care services, they must be deemed homebound by a medical provider. Homebound means that a patient is unable to leave their house to receive medical care and is typically only able to leave home in infrequent instances for events like religious services. However, if a beneficiary is enrolled in an adult day care program, they are still able to receive home health care.Part A (Hospital Coverage)
If a Medicare beneficiary was admitted to the hospital or a skilled nursing facility for three or more consecutive days, they are eligible for Medicare-covered home health care through Part A. Medicare Part A, known as Original Medicare’s hospital coverage, will cover home health services for 100 days as long as a beneficiary is due to receive home health care within 14 days of leaving the hospital or nursing facility.
Part B (Medical Coverage)
If a patient was not hospitalized prior to needing home health care, Medicare Part B will cover their services if home services are deemed medically necessary by a licensed provider.
Part C (Medicare Advantage Plans)
Medicare Advantage (MA) plans, otherwise known as Medicare Part C, work to fill the gaps in standard Medicare coverage and are provided by private insurance companies that are contracted through Medicare.
Since all MA plans include Part A and Part B coverage bundled into one health plan, home health services will be covered exactly as detailed above. However, since MA plans are provided by private insurance companies, certain plan types may require beneficiaries to seek in-network home health service providers. Beneficiaries should always contact a licensed insurance agent before selecting a home health provider to ensure no added out-of-network expenses.
Medicare Supplement Insurance Plans
Supplemental Medicare plans such as Medigap or Dual Eligibles (Medicaid-Medicare) assist beneficiaries with out-of-pocket costs that Original Medicare doesn’t cover. Supplement plans may assist beneficiaries with certain home health care costs that aren’t covered by Medicare. However, since these plans are provided by private health insurance companies, they may require beneficiaries to use providers or prescription drugs that are in-network.
Who Qualifies as a Caregiver?
When it comes to home health care, a variety of home health aides are available to assist patients with a wide range of needs. Common needs for beneficiaries include but are not limited to:
Companion Services: Providers that offer companionship for beneficiaries and assist individuals with finding livelihood and fulfilling daily activities.
Homemaker Services: Providers that assist beneficiaries with errands, housekeeping, making meals, and transportation.
Personal Care Services: Providers that assist individuals with personal care such as eating, daily hygiene, exercise, and more.
Skilled Care Services: Providers that assist individuals with medical needs such as dressing wounds, physical therapy, medicine dosage, and more.
When it comes to the individual providing home health services, beneficiaries have many options available to them depending on the care they need. All providers available for beneficiaries through a home health agency are approved by the federal government through the Centers for Medicare & Medicaid Services (CMS). However, it’s important to note that different providers supply different services.
Registered or Licensed Nurses: Nurses can provide skilled care services such as dressing wounds, giving injections or tube feedings, ensuring a patient’s home is safe, monitoring medications, etc.
Professional Therapists: Therapists provide specific care services such as speech therapy, physical therapy, or occupational therapy.
Social Workers: Social workers provide medical social services that are linked to a beneficiary’s social and emotional care. They will evaluate a beneficiary’s home situation, their financial burdens, how active they are in the community, and more.
Self-Directed Caretakers: In certain circumstances, CMS allows family members to provide long-term care for beneficiaries. However, those looking to become family caregivers must first apply, undergo assessment, establish a care plan, create a budget, and then the beneficiary gets the final say in who cares for them.
How to Find a Caregiver
To locate a caregiver in one’s community, beneficiaries can use Medicare’s provider search tool or the U.S. Administration on Aging’s search tool. These tools will allow individuals to find providers near them, compare those providers, narrow their search by agency or care type, and more.
It’s important when searching for a caretaker to evaluate them regularly to ensure they are a good match for the beneficiary’s needs. When searching for a caregiver, it’s possible to narrow down a search by the rate one is willing to pay for care. Based on a recent survey the monthly median cost of having an in-home caregiver in 2020 was $4,481. The cost of having a caretaker can range depending on the rate desired, the amount one’s Medicare or MA plan will cover, and where an individual lives.
If you're ready to enroll in Medicare, understanding the plan coverage and prices, and even what Medicare is going to cost you can seem complicated. And even after enrolling into Medicare, perhaps you want to ensure that the current plan you've selected is still the best fit for you. Contact Crystal Manning Licensed Medicare advisor at 412-716-4942 crystalmanning33@gmail.com or Dvonya Sedlacko 412-657-3889 djsedlacko@gmail.com
Comments