What This Change Means
The guidelines for what is covered in Medicare are expanding to non-skilled in-home care, which is a huge deal for those that require care but do not necessarily need a nurse or an assisted living facility. The decision to cover this type of home care is receiving an overwhelming amount of support.
Advocates are thrilled CMS is recognizing the significant benefits available through non-skilled home care. People who need help but couldn’t afford to hire a private professional company are now able to qualify for assistance.
Will Medicare Cover Skilled Nursing Care
Medicare will pay for whats considered intermittent nursing services, meaning that care is provided either fewer than seven days a week, or daily for less than eight hours a day, for up to 21 days. Sometimes, Medicare will extend this window if a doctor can provide a precise estimate on when that care will end.
Skilled nursing services are generally required to treat an illness or assist in the recovery of an injury. As the name implies, those who provide this care are licensed to administer medical treatment such as injections, catheter changes, wound dressings, and tube feedings.
The maximum amount of weekly care Medicare will pay for is usually 28 hours, though in some circumstances, it will pay for up to 35. But it wont cover 24-hour-a-day care.
Medicare And Caregiver Costs
Although Medicare has its limitations, it is possible to maximize the benefits it does offer. Covering caregiver costs has yet to be incorporated as part of a larger plan that includes not only Medicare but other state and federal programs as well. However, with some research and diligence, you can start to learn how to cover caregiving costs for you and your family.
How To Find A Home Health Agency
The Pennsylvania Homecare Association website includes a “Find a Provider” feature where you can search for an agency by location or by the services you need.
Home health agencies are licensed by the Pennsylvania Department of Health. You can also search for an agency near you on their website.
Whenever anyone on Medicare is discharged from a hospital and is prescribed home health services , a hospital social worker or case manager will present the individual with a list of Medicare-certified agencies to consider. When you find an agency, make sure it has been certified by Medicare so that the services qualify. Medicare certification also means the agency has met federal minimum requirements for quality patient care and management.
You can also search online to compare how well home health care agencies perform with Medicare’s Home Health Compare tool.
Choosing A Caregiver: Comparing Family & Friends Independent Contractors And Homemaker Service Agencies
Companion care costs may vary depending on who is delivering the services. While other care sectors like home health and assisted living are well-established, companion care is a bit like the wild-west.
You might find stay-at-home moms, independent contractors, and agency workers all competing in the same space. Not only that, but friends, families, and neighbors often offer informal companion care services.
Because of its infancy and lack of structure, the price of companion care can vary wildly. In this section, well describe typical costs and important considerations across the different types of companion care providers: family & friends, independent contractors, and agency workers.
In the following section, well pull everything together to help you estimate your own companion care costs in 2021.
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More Information About Medicare And Medicare Advantage
For more information about Original Medicare, Medicare Advantage, and Medicare Supplement Plans, read the following guides:
CMS Fast Facts. CMS.gov. . Accessed June 6, 2021.
Health Plans General Information. CMS.gov. . Accessed June 6, 2021.
Home Health Services Coverage. Medicare.gov. . Accessed June 6, 2021.
Medicare Advantage Plans. Medicare.gov. . Accessed June 6, 2021.
Original Medicare Eligibility and Enrollment. CMS.gov. . Accessed June 6, 2021.
What Part A covers. Medicare.gov. . Accessed June 6, 2021.
What Part B covers. Medicare.gov. . Accessed June 6, 2021.
Whats not covered by Part A & Part B? Medicare.gov. . Accessed June 6, 2021.
Your Medicare Coverage. Medicare.gov. . Accessed June 6, 2021.
How To Choose A Prescription Drug Plan
Having a variety of prescription drug plans to choose from gives Medicare beneficiaries the freedom to pick a plan that meets their unique needs. To help the beneficiary choose a plan that provides the right coverage at the best price possible, you as a caregiver can:
- Contact the Medicare plan directly
- Visit www.medicare.gov to view or print copies of Your Guide to Medicare Prescription Drug Coverage.
- Contact a licensed insurance agency, such as eHealth Insurance Services, Inc .
You can also find information in the Medicare & You handbook, which is mailed out to Medicare enrollees during the fall. It contains detailed information about Medicare prescription drug plans, including which plans are available in your area.
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What Does Medicare Cover
The official Medicare website operated by the federal government provides lists and a searchable database of services and items covered by Medicare. Mobile apps for Apple and Android devices are available in the respective app stores.
Members can also discuss the required services and items with their doctor or health care provider. This is generally the most convenient way to find out whether Medicare will cover something, although doctors and other providers may not be aware of uncommon requirements.
Below, you can see an overview of what health and medical services are and are not covered by Medicare.
Covered By Medicare
Durable medical equipment and some other medical supplies
A few of the items and services mentioned above may be covered by Medicare health plans offered by private companies, such as Medicare Advantage plans, but in general, these will be out-of-pocket expenses. Additionally, coverage provided by these private insurance companies varies based on location and provider, so its important to check with your primary care physician and/or use the search function on the official Medicare website.
Paying For Medicare And Health
As a caregiver, you should find out if the beneficiary has health coverage besides Medicare, such as a health plan with a former employer, Medicaid, or other insurance that can help pay for health-care needs.
Depending on the beneficiarys income level and resources, there may be additional programs available to help pay for health-care costs. Medicare Savings Programs can help pay for Medicare copayments, premiums, and deductibles for low-income individuals. For those who qualify, the Medicare Extra Help program offers a low-income subsidy for prescription drugs. Another option may be the state-run Medicaid programs, which help with medical and long-term care expenses for low-income individuals and families.
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Does Blue Cross Blue Shield Cover Home Health Care
- Blue Cross Blue Shield Medicare Advantage plans cover home health care services such as intermittent skilled nursing care, and some plans may also cover things like caregiver support, home-delivered meals, bathroom grab bar installation and more.
Home health care benefits can be an important part of an older adults health insurance coverage. Many seniors wish to age in place at home for as long as possible, but many may lack the independence to do so unassisted.
Anthem Blue Cross Blue Shield Medicare Advantage plans provide all of the same home health care benefits that are found in Original Medicare for plan members who have been deemed homebound and need part-time or intermittent skilled nursing care can qualify.
Some Anthem BCBS Medicare plans may also cover additional home health care services such as non-emergency medical transportation, home meal delivery, home health aides, caregiver support and more.
All Medicare Advantage plans including Anthem Blue Cross Blue Shield Medicare plans are required to cover at least the same benefits covered by Original Medicare. Many Medicare Advantage plans also offer other extra benefits not covered by Original Medicare, such as dental, hearing, vision, telehealth and more.
Whether Medicare Pays For A Caregiver Comes Down To The Level And Type Of Care You Need
The short answer here is: Medicare will sometimes pay for a caregiver. You or a loved one may need a caregiver for a wide variety of home care needs, and Medicare will only pay for a caregiver under a very limited selection of these. The basic idea to remember is that Medicare will pay for your caregiver if their care is part of an overall medical rehabilitation strategy, rather than if it is just general care and help in the home.
This is spelled out in various specific requirements that you should be knowledgeable about.
Also Check: What Is Medicare Part A And B
What Is Home Health
Home health provides skilled services, including nursing care and physical, occupational, speech and respiratory therapy. The agency will send a licensed professional to assess home health needs and develop a complete care plan. These services are usually short-term, as in the case of a person recovering from surgery or other health issues.
Medicare will cover home health if it is ordered by a physician and the person is homebound and in need of skilled services.
A home health care agency employs the healthcare professionals sent to the home and must be licensed by the state. Many seek additional accreditation to assure consumers that they have met quality standards. Common accreditations are the Community Health Accreditation Program , Accreditation Commission for Health Care and The Joint Commission .
Home Health Agency Care
In 2010, about 33,000 home health agencies served approximately 12,000,000 clients across the United States. Annual expenditures for home health care tin 2010 were projected to be $72.2 billion . In that year Medicare spending accounted for approximately 41 percent of home health expenditures. Although current figures are not yet available for 2014, the number of home health agencies has been going up year after year as well as the number of clients being served.
In the United States, the rate of home health care use for women aged 65 and over was 55% higher than the rate for men. Female home health care patients aged 65 years and over were more likely than male patients to be 85 years and over and were almost three times as likely to be widowed .
Home health agencies deliver a variety of skilled services outlined by the chart below. The plan of care always includes as well custodial services to help the care-recipient remain in the home. These would include an aide for an hour or two a day to help with bathing, dressing and transferring. If there is time remaining other personal services may be offered as well. These personal services are also covered by Medicare.
A common statement from individuals who are confronted with the need for long-term care planning is,
“I’m in good health, I’m going to live a long time and I won’t need long-term care.”
Source: 2009 Centers for Medicare and Medicaid Services, cms.gov
Will My Love One Be Covered
Medicare covers seniors over 65 years old.
Medicare is available for certain people with disabilities who are under the age of 65. That includes people who have received Social Security Disability Insurance for a total of at least 24 months, have end-stage renal disease or permanent kidney failure, or have Lou Gehrigs disease .
If you qualify for Medicare, its still not certain that your long-term care will be covered. Medicare concentrates on short-term care for conditions which will eventually improve.
This means Medicare will not pay for most long-term home care services or personal services such as help bathing, dressing, or help going to the bathroom.
To help you understand you or your loved ones ability to finance respite care or home care services, Visiting Angels offers free consultations over the phone and at your home.
How Does Someone Enroll In Medicare
As mentioned above, Social Security will automatically enroll an individual in Medicare when they become eligible, which is generally at age 65. Applications can also be submitted online at the federal Social Security website or in person at a local office. This should be done in the 90 days before or after the individuals 65th birthday to avoid complications such as added expenses.
The Social Security website provides a checklist of documents and information required in the enrollment process, as well as the ability to check the status of a submitted application. This allows seniors to enroll in Part A generally at no cost and theyll also have the option of enrolling in Part B, which does have a monthly premium attached.
The Centers for Medicare & Medicaid Services will then send successful applicants their Medicare card and a welcome packet in the mail, which contains useful information and advice on what to do next.
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When Will Medicare Pay For A Caregiver
For the most part, whether Medicare will cover in-home caregivers depends on exactly what type of care one is receiving. Keep in mind that to remain eligible for Medicare at-home medical care coverage, you will need to see your doctor fewer than 90 days before, or 30 days after, you begin to receive home healthcare services.
In the following scenarios, Medicare benefits may apply:
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- Find Plans That Cover Your Doctors and Prescription Drugs
Medicare Advantage, also called Medicare Part C, is the supplemental plan that covers non-skilled in-home care. Medicare Advantage plans are an alternative to traditional Medicare , both of which dont cover non-skilled in-home health care.
Not all Medicare Part C plans have the same coverage and benefits. Because theyre sold through independent insurance companies, rather than delivered by the federal government, some of the benefits vary by company.
Most Medicare Part C plans do cover non-skilled in-home care, including medication management, personal assistance with bathing and grooming, mobility assistance and help with catheters or colostomy bags. They also provide subscribers with postsurgical or recovery services to prevent complications and reduce the need for extended or emergency hospital stays.Medicare Part C plans vary by region, as well. Applicants are encouraged to research available plans in their area and the services offered. The Medicare Plan Finder tool assists seniors in finding plans in their state or city to fit their budget.
Also Check: How Do You Sign Up For Medicare Part B Online
Does Medicare Pay For Home Health Care For Dementia Patients
Medicare covers some types of home health services, such as intermittent skilled nursing care as well as physical, occupational, and speech therapy. But, Medicare only covers services that a doctor orders at a certified home health agency.
Medicare wont cover:
- Help with shopping, laundry, or errands
- Round-the-clock care
What Medicare Prescription Drug Plans Cover
Each Medicare prescription drug plan, whether it is a stand-alone plan or a Medicare Advantage Prescription Drug plan, has a list of prescription drugs that it covers. This list is called a formulary, or drug list. Plans may cover both generic and brand-name prescription drugs. Most prescription drugs used by Medicare beneficiaries will be on a plans drug list. To find out which drugs a plan covers, contact the plan or visit the plans website.
Medicare drug plans may have rules about prior authorization, quantity limits, and step therapy:
- Prior authorization means that the beneficiary and/or the doctor must contact the plan before certain prescriptions can be filled. The doctor may need to show that the drug is medically necessary for it to be covered.
- Quantity limits are limits on how many pills or doses a beneficiary can get at a time.
- Step therapy is a type of prior authorization in which a beneficiary must try one or more similar, lower-cost drugs before the plan will cover the drug the doctor prescribed.
If the doctor believes that one of these coverage rules should be waived, the person can ask for an exception.
National Federation Of The Blind Vs Centers For Medicare And Medicaid Services
What happened in 2016 to change Medicare for the blind? Three blind beneficiaries decided to challenge how Medicare information is provided to those who are blind or have low vision.
This dispute brought attention to those who are Medicare-eligible and blind and highlighted that they are not provided with equal access to Medicare information. They explained that there was a lack of materials available to someone who was blind or had vision loss.
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No Medicare Doesnt Pay For Assisted Living
Thats because Medicare doesnt cover the cost of room and board or non-skilled assistance with daily activities , which make up the majority of assisted living care.
However, whether your older adult lives in their home or in an assisted living facility, Medicare will continue to cover prescription medications and/or other medical services that would normally have been covered by your specific plan.