Exploring Medicare and Medicaid Payment Options for In-Home Care for Senior Loved Ones
Caring for senior loved ones is a responsibility many of us face, and finding the means to pay for in-home care can be a crucial aspect of ensuring their well-being. In this article, we will explore various payment options available, including Medicare benefits, Medicare Advantage plans, Medicaid, veterans programs, state-funded programs, self-payment options, home care loans, and long-term insurance.
What Alliance Senior Care Can Offer
Making sense of paying for In-Home Care for a senior loved one can be daunting at the least, especially in a time of crisis or when an unexpected health challenge happens.
Alliance Senior Care offers a free consult to help you make sense of your options. You may have some benefits you were not aware of which can help you pay for In-Home Care. Call us and schedule a free consultation. Here are some payment options and benefits for In-Home care.
Medicare Benefits (Original Medicare)
Medicare, a federal health insurance program primarily for individuals aged 65 and older, offers limited coverage for in-home care services. To qualify, certain criteria must be met, such as requiring skilled nursing care or therapy.
Original Medicare does not pay for non-medical, home care aides and only selectively covers home health care. Medicare Advantage, on the other hand, may cover non-medical, home care aides depending on one’s plan.
There are many misconceptions around Medicare’s benefits for In-Home care. Original Medicare, also referred to as traditional Medicare, does not pay for non-medical care, period.
Therefore, assistance for non-medical care provided in the home is not covered. Medicare Supplemental Insurances cover Medicare co-payments and deductibles. But they do not add new areas of coverage. So these policies are of no assistance for non-medical home care.
However, when home health care is considered medically necessary, it is covered, at least in part, by Medicare and other health insurance programs.
However, original Medicare severely restricts coverage to only those individuals who are “homebound”. This is defined as persons who require assistance (by human or medical equipment, such as wheelchairs) to leave their homes.
Alternatively, persons whose health may be worsened by leaving their homes are also eligible. During home health care visits, Medicare will not pay for any personal care that is provided during that visit. Visits tend to be brief and procedural in nature.
The exception to the limited home care rule are Medicare PACE programs. But, these are available only in limited geographic areas.
Medicare Advantage plans, also known as Medicare Part C, are private insurance plans that provide an alternative to traditional Medicare. Some Medicare Advantage plans may offer additional coverage for in-home care services beyond what original Medicare provides.
New in 2019, Medicare Advantage (MA) plans are able to offer supplemental health care benefits to their participants. CMS does not clearly define “supplemental health care benefits.” But they are interpreted to include benefits that:
- Offer compensation for a functional need
- Are used to prevent or care for an injury
- Lessen the likelihood of requiring emergency or health care
Several in-home services may be available via one’s MA plan, such as;
- home health aides
- personal care assistance
- palliative care, and meal delivery
Other benefits that may be available include
- adult day care
- non-medical and medical transportation
- home modifications to aid aging at home, among others
Starting in 2020, MA plans will be able to offer even greater flexibility when it comes to supplemental benefits. In fact, MA plans will be able to offer non-health related supplemental benefits for persons with chronic conditions, which includes Alzheimer’s disease and related dementias.
This is provided that it is reasonably expected that the goods and services will improve or maintain one’s functioning or health. In addition, benefits can be customized for the individual in need.
Medicaid is a joint federal and state program that offers healthcare coverage to low-income individuals, including seniors. Medicaid benefits vary by state, and some states provide coverage for in-home care services through Home and Community-Based Services (HCBS) waivers. Eligibility requirements, including income and asset limits, must be met to qualify for Medicaid and its related programs.
Medicaid rules are state-specific. Therefore, eligibility and benefits differ in every state.
When Medicaid provides care outside of nursing homes, it is referred to as Home and Community Based Services (HCBS). HCBS can be covered under the following:
- Regular Medicaid, often called State Plan Medicaid
- Medicaid Waivers, also called 1915(c) Waivers or HCBS Waivers
- A relatively new state plan program called the Community First Choice Option (CFCO)
Regular / State Plan Medicaid is an entitlement program, as is CFCO. Anyone who meets the eligibility requirements is able to receive entitlement services. However, waivers are not entitlements.
A limited number of slots are available and waiting lists are fairly common for Medicaid waiver programs. Most states cover home care for the elderly (both non-medical and home health) in both their State Plan and their waivers.
To get started with In-Home Care can help improve your loved ones’ quality of life, call Alliance Senior Care at 248-274-2170. It’s not just In-Home Care, it is Integrated Care.
Home Care Services are an excellent resource for family caregivers and seniors alike.
Alliance Senior Care Home Care services offer a wide range of services providing healthcare, daily living assistance, transportation to and from Doctor’s appointments and tailored care services for additional circumstances.