In-home care is designed to support activities of daily living (ADLs) while maintaining a person’s quality of life and preserving their dignity. There are many health conditions that may require help from a caregiver, such as Parkinson’s disease, dementia, cancer, spinal cord or traumatic brain injuries, development disabilities, HIV/AIDS, advanced heart disease, stroke, multiple sclerosis, debilitating arthritis, or advanced diabetes. While many elderly individuals prefer to remain in their homes as they age, not all have this option due to financial challenges. In some instances, Medicare will cover in-home health care services if a patient meets certain eligibility requirements.
Rising Home Health Care Costs
Home health care has been steadily on the rise since being introduced to the U.S. in the 1880s. Today, approximately 12 million people receive care from over 33,000 providers. When older adults reach the retirement years, they must make a decision about where to spend their golden years. Elderly individuals with ongoing medical problems are often advised to move to nursing homes. Unfortunately, the median cost of a private room in a nursing home currently tops $100,000 per year.
According to a 2018 “Cost of Care Survey,” the cost of long-term care has increased 54 percent for a private room in a nursing home and 67 percent in an assisted living facility. What makes in-home care an attractive option is the ability to receive high-quality personal care from experienced RNs, LPNs, home care aides, physical therapists, occupational therapists, and social workers in the comfort of the person’s familiar home. Compared to the cost of nursing homes and assisted living facilities, in-home care services can be quite affordable. In-home health care is best suited for elderly individuals who require help with daily care but do not necessarily need medical care.
Medicare for In-Home Health Care
Medicare may pay for the cost of in-home health care services if the elderly person meets certain qualifications. Depending on the circumstances, these services may be covered by either Medicare Part A or Part B. Under Medicare Part B, you may be eligible for in-home care if you are considered homebound and require skilled care. You do not have to have prior hospitalization to be eligible for Part B coverage. There is also no deductible or coinsurance for Medicare Part B in-home care. Most types of home health care are covered by Part B.
In some instances, Medicare Part A may cover the cost of in-home health care temporarily. Part A coverage may be applicable if an elderly person was previously in a hospital or skilled nursing facility (SNF). To be eligible, you need to have stayed in the hospital as an inpatient for at least three consecutive days. Alternatively, you need to have had a Medicare-covered SNF stay. However, Medicare Part A will only cover home health care services for the initial 100 days. The patient then must meet the eligibility requirements for Part B to continue with home health care services.
For Medicare to cover your in-home care, you must meet the following qualifications:
- You are homebound, meaning it is highly difficult for you to leave your home and leaving requires the assistance of others.
- You require skilled nursing or therapy services on an intermittent basis. This means you require care at least once every 60 days or as frequently as once a day for up to three weeks. If you require ongoing care, this period can be longer. Skilled care refers to physical, occupational, or speech therapy services performed by skilled professionals or given under the supervision of skilled professionals. Note that you cannot qualify for Medicare in-home care if you require occupational therapy only.
- You have a face-to-face meeting with a licensed medical professional within 90 days of starting in-home care or within 30 days from the start of care. This meeting can occur in a hospital setting, office setting, or via technology, such as a video conference.
- You receive a signed home health certification from a doctor that confirms that you need intermittent skilled care. You must also obtain an approved care of plan from your doctor.
- You must receive your in-home care from a Medicare-certified home health agency (HHA).
If you are approved for Medicare in-home care, know that Medicare will pay for certain services. These typically include part-time or intermittent skilled nursing care, medical social services, physical therapy, speech-language pathology services, occupational therapy, and part-time or intermittent home health aide services, or personal hands-on care. There are certain in-home health services that Medicare does not pay for, such as 24-hour-a-day care at home, homemaker services, meals delivered to your home, and custodial or personal care, such as dressing, bathing, or using the bathroom, if this is the only care that you need.
Elderly individuals who qualify for Medicare in-home care services will generally pay nothing out of pocket for their home health care if the services are ordered by a doctor and administered by a certified in-home care agency. However, individuals who require additional health services outside of their approved plan may not receive coverage from Medicare and will need to pay these extra expenses out-of-pocket. Before starting services, you should receive a written “Advanced Beneficiary Notice of Non-coverage” (ABN) from their in-home health agency that will detail all of the services and equipment that Medicare will pay for and what expenses the patient is responsible for.
Learn More About In-Home Care
Paying for health care can be challenging for elderly adults who may require skilled nursing care or other essential services. Many of these individuals rely on Medicare to cover the cost of care following retirement. However, not all elderly individuals will qualify for Medicare coverage. It is important to understand that Medicare will generally only pay for in-home health care expenses that are deemed medically necessary. For more information about in-home care or to find out if you may qualify for Medicare coverage for home health care services, contact the friendly professionals at Comfort Home Care today.