Does Medicare Extend Coverage to At-Home Care Services?

Dear Toni,

Advertisement.

I need your help regarding my parents who are in their late 80s. My mother has been disabled with Parkinson’s for the past 3 years and my father has been her caretaker, but due to his recent heart attack, he can no longer assist her.

They do not have a long-term care plan, and discussing having live-in help or living in an assisted living facility is out of the question. My parents’ big worry is that they will outlive their retirement money and be unable to provide financially for themselves. My concern is that my parents cannot properly take care of themselves and that something serious could happen to them living on their own. 

Advertisement.

What is the difference between home health care and at-home care? Will Medicare pay for at-home care?

Samantha

Hi Samantha,

Do not feel like you are alone with this problem of aging parents because many Baby Boomers are experiencing just what you’re facing. Elderly parents do not want to lose their independence by not controlling their finances. This type of situation is especially difficult when they can no longer care for themselves properly as you, Samantha, are experiencing with your parents.

I had the same stressful issue with my own mother and discussed different options with a home health agency, who explained how to maximize my mother’s Medicare dollars with home health care benefits, not at-home care. 

To receive home health care services from Original Medicare (not a Medicare Advantage Plan):

1. There must be a medical need to receive home health care services. 
2. Primary care or specialists must order home health care services.
3. You must need intermittent skilled nursing care, physical, speech, or occupational therapy.
4. The home health agency must be Medicare-certified. (If not, Medicare certified, then you pay 100% of the home health charges.)
5. You must be homebound. (“Homebound” means not leaving home without help from someone or aid from a wheelchair, walker, cane, etc. due to illness or injury.)

Once these conditions are met, Original Medicare will cover these types of care:

• Skilled nursing care performed by a licensed caregiver.
• Home health aide care to assist in bathing, dressing, and other personal care that must be part of the health care for illness or injury.
• Physical, speech, or occupational therapy can be ordered.

If you have Original Medicare, you typically won’t face a co-pay or deductible for home health care. Medicare covers 100% of covered services provided by a home health agency that accepts Medicare assignment.

Those with “Original” Medicare, not Medicare Advantage plans, have “Patient’s Rights” with the right to choose which home health care agency to use. Those enrolled in an Advantage plan must use network providers and can limit how much home health care one receives. Be sure which way your elderly family members are receiving their Medicare benefits!

Under Original Medicare or a Medicare Advantage plan, home health care is limited with regard to the time spent at home with the patient. It does not help with daily at-home care of the elderly once the medical need is taken care of that day.

At-home care is not a Medicare option and is paid for with your personal dollars, not Medicare dollars. “At-home care” is a non-medical, in-home care for the elderly in support of aging while at home. Samantha, it can help to build a long-term care needs plan with care at home from a few hours to 24-hour care per day. Email your long-term care questions to info@tonisays.com!