Medicare covers many senior care services. Although, there are exceptions, limitations and costs you need to know about.
Understanding the coverage Medicare provides will make receiving care easier. When you know what to expect, you can plan accordingly.
Medicare Coverage: Exceptions to the Rules
To determine whether your loved one's healthcare needs are being met, you will need to understand the options available for senior care. Depending on the circumstance, Medicare coverage may be available.
It's important to clearly understand the exceptions to the 'rules' of Medicare coverage. This could make all the difference in you or your loved one's cost of medical expenses.
What is Skilled Care?
Skilled care can be things like IVs as well as physical or occupational therapy.
Medicare won’t cover costs for long-term stays in nursing homes or other long-term care facilities. Additionally, Medicare won’t cover cost for short-term visits, unless the patient was hospitalized.
After being in the hospital for a minimum of three days, Medicare will pay the entire cost of your care in a long-term facility for up to at least 20 days.
After the 20 days, a coinsurance of $170.50 is expected for each day. Medicare will cover the cost for every day past 101 days.
Majority of Medicare Supplement Plans cover the cost of coinsurance.
You Might Need In-Home Care
If you have a loved one that needs in-home care, just know you’re not alone. Approximately 12 Million Americans require some form of home health care.
You may have noticed a loved one:
- Living in a house that is much less tidy
- The fridge has expired food that has yet to be thrown out; is the mail piling up
- Are bills not being paid or is your loved one forgetting to make payments on time
- Is assistance needed with bathing or with taking medications properly
If you answered “yes” to any of these questions, a caregiver could offer great assistance.
Personal drivers are another great option if your loved one is unable to drive themselves safely to scheduled appointments, stores or other personal affairs.
Remaining in the comfortability of their own home is likely to be a priority for your loved one; determining what is covered by Medicare will help you from racking up unnecessary bills during this time.
In-Home Health Care Coverage offered by Medicare
If patient is homebound, has difficulty leaving the home, or requires assistance, then home healthcare could offer relief to the family members trying to handle these tasks.
Skilled nursing services or skilled therapy that is needed on an intermittent basis is also possible. This would mean care is needed at least one time every 60 days or at most once a day for a maximum of 3 weeks.
If care is required for longer than 3 weeks, this period may be extended. However, 90 days prior to starting home health care a face-to-face meeting with a healthcare professional is required
Face-to-face visits can be either an:
- office visit
- hospital visit
- Or, under special instances these visits may be conducted through technology (like a video-conference)
A home health certification signed by the patients' doctor must confirm that the patient is homebound and needs intermittent skilled care. This certification must include the doctors approved plan of care, and proof of face to face visit.
Home health plans should be reviewed and certified every 60 days by the patient's healthcare provider. Face-to-face meetings aren’t required for recertification.
Skilled care, as defined by Medicare, MUST be performed by a skilled professional, or at least under the supervision of a skilled professional. Physical, speech and occupational therapy are all considered Skilled therapy services.
Medicare Coverage for Assisted Living
For loved ones who need help with many daily living activities an option is moving them into a facility. Medicare coverage in assisted living facilities is available; however, the coverage is limited. If the patient is living at an assisted living facility, Medicare will still cover the services that the patient would normally receive if they were living independently.
Medicare co-payments and deductibles must still be met; and coverage includes:
- Doctor visits
- Lab tests
- Certain preventative services
- Physical therapy
- Occupational therapy services
- And Medical supplies
Neither Medicare Part A nor Part B will cover the assistance with activities of daily living (ADLs) that many assisted living residents need.
An ADLs resident will generally be able to provide some care for themselves. However, bathing, dressing, eating, or toiletry assistance is often something they need.
Memory Care Coverage
Across the country, people are suffering more and more from advanced dementia. The focus is on making the environment easier and safer for people who can't use their best judgment when making decisions. Facilities such as these are locked for safety of the patients. They help with administering medications properly, ensuring patients are eating and receiving daily meals.
Assistance includes maintaining medical oversight and aiding in carrying out daily activities, such as:
- And incontinence care when needed
Medicare beneficiaries will receive coverage for some, but not all, memory care costs.
For patients with dementia or Alzheimer's who are 65 or older, Medicare covers:
- Inpatient hospital care as well as some of the doctor expense
- Medicare Part D may also cover costs of prescription drugs
- Up to 100 days of skilled nursing care may be covered under certain circumstances
Please Note: custodial (help with feeding, bathing, dressing and other day to day activities) long-term nursing home care is not covered by Medicare. Medicare will cover costs for hospice care that's received in the patients' home, or an inpatient hospice facility/nursing facility
Adult Day Care
Many people will desire to stay in their own home, even if they need to live with a caregiver; certain licensed facilities provide daytime-only care to individuals like these. The idea of these facilities is to relieve the caregiver, giving them some time to relax or tend to other responsibilities.
The Majority of Adult Day Cares are funded by Medicaid; however, private pay options are also available.
For seniors that are suffering from advanced dementia or are chronically ill, this could be a great option to consider. Typically, Medicare won’t cover any type of adult day care (ADC). Some Medicare Advantage Plans might provide coverage for a portion of these services. However, Medicare Advantage Plans aren’t required to offer coverage.
Everything You Need to Know About Senior Care Services
Understanding your Medicare coverage can make budgeting your healthcare easier. When you have a question or concern, contact a Medicare insurance expert in your state. Many senior care services are covered under Medicare; however, not all services are coved in full or at all. It’s your responsibility to know and understand the plan’s limitations, exemptions and coverage.
Lindsay Malzone is the Medicare Consultant for MedicareFAQ. She has worked in the Medicare industry since 2017 and is featured in many publications as well as writing Medicare focused columns for other publications.
©Copyright - All Rights Reserved
DO NOT REPRODUCE WITHOUT WRITTEN PERMISSION BY AUTHOR.