In the home care business, we are often asked about alternative financial resources to help pay for home care costs. These costs can become prohibitive and a financial burden on seniors and sometimes their families. Medicare has approved certain non-skilled in-home care services to be covered under Medicare Part C, also known as Medicare Advantage. Often callers think home health care costs are the same as in-home care. It’s very confusing that Medicare covers home health care costs as “skilled” services while in-home care is considered a “non-skilled” service.
Medicare Advantage was created to enhance the Medicare program by offering beneficiaries more comprehensive coverage options, potential cost savings, and improved care coordination through private insurance plans. When Medicare approves a service, it does not necessarily mean it will be paid for through Original Medicare. Instead, it allows private insurers participating in Medicare Advantage to include it as part of their plans. This is why coverage can vary between insurers, similar to the differences in drug formularies from one provider to another. This variation allows Medicare recipients to shop for the availability of non-skilled in-home care annually at renewal time. As with any insurance situation, you need to get the insurer's agreement to pay for non-skilled in-home care and follow their guidelines for it to be reimbursed. Insurers carefully monitor the financial results of their offerings to ensure they are beneficial for their insured members and Medicare.
Paying for Senior Care
Medicare Advantage, or Medicare Part C, can include coverage for non-skilled in-home care. These plans are an alternative to traditional Medicare (Part A and Part B), which do not cover non-skilled in-home health care.
Not all Medicare Part C plans have the same coverage and benefits. Benefits can vary by company because they are offered through private insurance companies rather than being delivered directly by the federal government.
Some 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 may also provide post-surgical or recovery services to prevent complications and reduce the need for extended or emergency hospital stays. Medicare Part C plans vary by region, so applicants are encouraged to research available plans in their area using tools like the Medicare Plan Finder to find plans that fit their budget and needs.
What Services Are Included with Non-Skilled In-Home Health Care?
In-home health care allows seniors and those with qualifying disabilities to maintain independence in their own homes. Medicare Part C plans have evolved to allow some of these newly covered services to be provided by a professional caregiver or a family member chosen by the recipient. However, Medicare Part C-covered caregiver services are typically limited to a certain number of hours per year, so it is important to talk to the provider to understand these limits.
Respite Care
Some plans cover respite care, which can come in three forms:
- Short-Term Stay: This may include stays in a nursing home or an assisted living facility, often used by those recovering from surgery or whose caretakers need a temporary break.
- In-Home Respite Care: This allows caregivers to take a break while the patient stays at home, with professional caregiver services covered by the Medicare Advantage plan.
- Adult Daycare: These centers combine social activities with supervision and personal care, providing seniors with opportunities to socialize and reduce isolation.
Other Potentially Covered Services
Additional home health care services might include home modifications (e.g., wheelchair ramps, grab bars in bathrooms) and preventative services such as nutritious meal plans and healthy lifestyle lessons to reduce medication and surgery needs.
Here is a brief list of other Options for Paying for Home Care. If the senior is a veteran, the VA may provide reimbursement for non-skilled in-home care or services through a contracted VA provider. Each county has its own County Veteran Service Officer who can assist with navigating these options.