Medicare coverage for in-home caregivers is available in few situations; also, the level of benefits depends on needs. Meaning, qualifying beneficiaries may get coverage for care at home — however, the extent of care comes with restrictions.
One of the most critical issues in our healthcare system is the lack of coverage for in-home caregivers. As the baby boomer generation retires, more seniors need help with daily activities.
The shift has put a strain on many families due to not having the proper support. For those that bought Long-Term Care insurance or a life insurance policy with a long-term care rider, that could be the best financial solution for in-home care.
However, many people fail to buy this coverage before it’s needed. If that’s the case, annuities, savings, and a reverse mortgage are often choices people make to afford the necessary care.
There are some instances in which Medicare does cover in-home caregivers; we’ll discuss these situations below.
Medicare Coverage for In-Home Caregivers
Medicare may cover medically necessary at-home care on a short-term basis. Your doctor must prescribe at-home therapy before Medicare applies.
Medicare doesn’t cover in-home care when it involves personal services, and that’s the only care you need. Under strict guidelines, coverage for in-home caregivers is available.
When your parent begins to age, they may become homebound certified by their doctor. In this case, reimbursement for medical in-home services may be available.
The doctor must order rehab therapy visits or intermittent skilled nursing services to treat your condition. Although Medicare only pays for therapy short-term.
Skilled care must be from a certified Home Health Agency through Medicare. However, if you have long-term care coverage, you don’t need to worry about Medicare approval.
Does Medicare Pay for Caregivers
Many seniors need help with daily activities like dressing, bathing, doing the laundry or house chores, and other daily activities.
In-home care for non-medical reasons doesn’t have coverage. Families often struggle when trying to take care of their loved ones without the support of Medicare.
Caregivers may provide baths on a short-term basis; a healthcare professional must provide these services, and a person’s health status must require home health care.
Medicare pays for the medical expenses it deems allowable.
Does Medicare Cover In-Home Care for Seniors
In-home services must come through a Medicare-approved Home Health Agency. Medicare covers in-home care for seniors with personal, hands-on care for an intermittent time.
Beneficiaries must meet health requirements.
Home health agency services in Florida, Illinois, Michigan, Texas, and Massachusetts may offer a Medicare demonstration program. This program gives you and your home health agency an earlier idea of coverage.
Medicare reviews your situation and pays the allowable expenses if the services are medically necessary, and you meet conditions.
Will Medicare Pay for Home Health Care
Home health care covers a wide range of services. Medicare pays for home health services like occupational and physical therapy. They also include speech-language pathology services.
Part-time or intermittent care is available for home health aide and skilled nursing services. Hospice care, even at home, is likely under Part A coverage.
Also, any Durable Medical Equipment you need during home health care costs 20%, unless you have a Medigap plan to fill in the gaps.
Does Medicare Cover Home Instead
Home instead is a private company that provides senior care services to help with a variety of issues. The costs for Home Instead care vary; some insurance covers home care, Medicare doesn’t.
However, if there is a medical need for care, Medicare will pay for services at home. Medicare won’t cover things like live-in caregivers, visiting angels, or other custodial services.
Will Medicare Pay for 24 Hour Home Care
No, Medicare will not pay for 24-hour home health care. A home health care agency typically is the coordinator for any services your doctor orders.
Medicare doesn’t cover around the clock care at home or other home-maker services. Any meal deliveries to your home are not typically available.
Does Medicare Cover Personal Care Services
When the only care you need is personal care services, Medicare considers this custodial and doesn’t pay for these services.
Personal or custodial care includes needing assistance with simple life tasks such as using the bathroom, getting dressed, or bathing.
What Home Care Services Does Medicare Cover
The type of care you need determines whether coverage is available or not. Medicare covers in-home skilled nursing care and physical therapy.
Other in-home therapy services include speech and occupational therapy.
Medicare pays for these services when they focus on improving the medical condition. Further, Medicare pays for short-term care at home.
Who Qualifies for Home Health Care Services
All enrollees qualify for home health care services under specific conditions.
However, Medicare expects the following to qualify for home health care:
- You’re under the supervision of a professional that reviews your treatment plan frequently
- The doctor certifies that you need skilled nursing care or other forms of therapy
- Your doctor confirms that you’re homebound
- You only need speech, physical, or occupational treatment on a short-term basis
- Skilled nursing is only intermittent or part-time
- Medicare must approve the home health agency used
After meeting all conditions, beneficiaries typically don’t pay for in-home care.
Do Medicare Advantage Plans Cover Home Health Care
For the first time in 2019, advantage plans are allowing coverage for a range of in-home care services. Although only 3% of policies offer in-home support like personal care and housekeeping.
However, new supplemental benefits are now an option, just on a bigger scale. About 13% of plans cover family caregiver support like respite care and counseling.
On the other hand, 47% of Medicare Advantage plans are beginning to pay for nicotine replacement therapy.
Times are changing, and in-home care is necessary for many seniors in the U.S. As the baby boomer population grows into retirement, more people need in-home care.
Get Help with Medicare Coverage for In-Home Caregivers
At some point, you may need services that require home healthcare insurance. If you need help with coverage, you’ve come to the right place.
Some beneficiaries may qualify for the PACE program, and other social services help drive programs to provide community care to low-income Americans.
As seniors, you still have many choices, and we can help you find the right option for your health care needs and budget.
We can help answer your questions and get you rates from all the top companies without you needing to call each top company individually.
Give one of our agents a call today at the number above or fill out our online rate form today. You’re just a phone call away from your policy match!