Will Medicare pay so my care recipient can age in place?
Depending on the circumstances, Medicare may help cover services that involve skilled nursing, social work, or physical, occupational, or speech therapies. There are some general guidelines that apply, though, so it’s always good to consult with someone like an Area Agency on Aging Benefits Specialist, or an elder law attorney who can help you navigate these care rules.
What are some of the rules?
- A Medicare doctor must prescribe the care during a face-to-face appointment.
- The person needing care must be homebound, meaning they require special durable medical equipment, like a cane or walker, to leave the home.
- Medicare often doesn’t cover care if someone only needs custodial care, like feeding or assistance with bathing.
Home and community-based services
A variety of home- and community-based services may be available to help with your personal care and activities. Medicaid may cover some services, including:
- Home care (like cooking, cleaning, or help with other daily activities)
- Home health services (like physical therapy or skilled nursing care)
- Transportation to medical care
- Personal care
- Respite care
- Case management
Medicaid programs vary from state to state. Medicaid may offer more services in your state. Call your Medicaid office for more information.
Although Medicare does cover a number of home health care services, including skilled nursing, it does not pay for all the care. Both Medicare Part A and Part B have deductibles, coinsurance, and copays that the patient is responsible for.
For home health care that falls under Medicare Part B, Medicare will pay for 80% of the cost of care after the patient meets the small annual Part B deductible. Some Medicare beneficiaries are enrolled in Medicare supplemental coverage that may help to cover some or all of this cost-sharing. And Medicare does not cover long-term care in a nursing home or assisted living facility. It will pay for the medical care received while living in such a facility, but it does not pay for the facility itself. For people with low income and few assets, Medicaid does provide financial assistance for long-term care.
You should plan ahead to pay for this on your own or via a long-term care insurance policy that you established when you were still healthy. If you are unable to pay for his care, you might qualify for financial assistance from Medicaid, which is a health care program for people with low incomes and assets.
We hope this information is helpful to you in the important work you do as a family caregiver.
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