Does Medicare pay for Home Health Care?
The federal government created Medicare in 1965 so retirees could have quality health insurance after their employers stopped paying premiums. That Original Medicare program still covers hospital services under Part A, and it covers medical insurance needs such as doctor visits and limited home health care services under Part B.
Medicare Part C, or Medicare Advantage (MA) health insurance plans are from private insurers. Specific MA plans can offer more comprehensive plans with more coverage options than Original Medicare.
You may be thinking, “Yes, but it’s 2019, and I have certain needs. Does Medicare pay for home health care now?” The simple answer is yes, but specific plans cover different services.
Medicare Home Care Benefits
Over the past few years, home care services have greatly expanded. More and more seniors prefer to receive the care they need at home instead of in a nursing home or other facility. However, nursing homes and long-term care facilities can be more expensive than home care, because home care eliminates the need for room and board.
Kaiser Health News reports that over six million American seniors require home care. That means that they need help with dressing, bathing, eating, and other daily activities. However, a basic Medicare plan may not provide enough coverage for home care.
Having a nurse or aide in your home can cost well over $40,000 per year. With long-term care insurance, you’ll pay a premium instead, and your yearly costs will total at just over $2,000. You’ll need to determine how much coverage you need ($50 per day, $100 per day, etc.) and what you’ll be using it for. You can use a long-term care policy for anything from a full-time nurse to home modifications, like ramp installations.
What Medicare Covers
Medicare does pay for some home health care services if leaving your house is a tremendously difficult process and you need assistance.
Parts A or B (Original Medicare) covers skilled nursing services on an inconsistent basis – at least one time every two months, but only up to once a day, and only for three weeks at a time. “Skilled care” means that it has to be performed by a qualified health care professional, or at least under his or her supervision.
Medicare Parts A and/or B will also cover physical therapy for recovery from injuries or illnesses, occupational therapy to help you learn how to perform day-to-day tasks with or without tools, and social services for medical needs.
While Original Medicare will cover basic home care, services such as housekeeping and meal delivery fall under specific Medicare Advantage (Part C) plans.
How to Find Affordable Senior Care
Medicare Advantage Plans (MA) plans are now allowed to cover a wide variety of home health care services. However, only a few private insurance companies will offer those services.
According to the American Association of Retired Persons (AARP), only 3.4 percent of MA plans will offer in-home support services, and 0.9 percent will offer in-home palliative care (care for people with life-restricting illnesses). With that knowledge in mind, it is crucial that you find someone who can help you navigate through the thousands of plans available, and locate one of the plans that can suit your needs and get you the care you deserve.
How do I Qualify for Home Benefits?
To qualify for home benefits, a doctor will need to certify that you have a medical need. For example, your policy will not pay for your stair lift if you still can walk up the stairs on your own without too much difficulty. As another example, if you only need a nurse to help you with something occasional, like blood transfusions, your policy will not pay for you to have a full-time live-in nurse.
Your doctor will have to meet you in person to determine that you are homebound and need skilled nursing care. After your initial certification, your doctor must recertify your home health care plan once every two months. A Medicare-certified home health agency (HHA) must provide the care.
When you Should Buy
Like other health insurance policies, you should buy a long-term care policy before you need it. Pre-existing conditions and your age can raise your premiums. If you buy while you’re still healthy, you’ll likely have lower costs. However, if you can’t afford the premium now, while you’re healthy, then it may be best to wait.
One of our licensed and experienced agents can help you figure out if a long-term policy is something you should buy now or wait for. If you think it’s time to buy now, we’ll help you find a great plan in your area.
To set up an appointment, call 1-844-431-1832 or contact us here.
This post was originally published on December 07, 2017, by Anastasia Iliou, but was updated on April 17, 2019, by Troy Frink.