Will Medicare Pay for In-Home Care?

Families are quite distressed when they discover that Medicare will not pay for a home caregiver.

By Clare Absher RN, BSN  

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Nurse taking blood pressure of senior woman.

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Families are often surprised if not dumbfounded to learn that Medicare does not pay for most in-home care for their elderly parents. Medicare will not reimburse in-home caregivers to assist aging loved ones with basic activities of daily living (ADLs) such as personal care, meal preparation, transportation, medication reminders and housekeeping.  In-homecare often referred to as custodial care is not covered by Medicare in spite of the dire need of these services by countless seniors. Furthermore it is exactly these non-medical homecare services that enable seniors to remain safely in their homes and age with dignity. Home care that is considered non-medical in nature is sadly not an allowable expense covered by our national Medicare program.  Whether it is part-time, fulltime, or even live-in homecare the answer is still a resounding NO when it comes to Medicare reimbursement.  Numerous families understandably are quite distressed when they unexpectedly discover that Medicare will not pay for in-home care to support their aging parents.

Nevertheless there are some specific circumstances when Medicare does pay for in-homecare services but under the strictest of guidelines. Medicare reimburses for skilled or medical in-home services when your elderly parent is certified by a physician to be home bound and the physician orders intermittent skilled nursing or rehab visits (PT, OT, ST). These stipulated skilled care visits must be provided by a Medicare certified Home Health Agency and are for a sanctioned period of time. Home health aide visits to provide a bath a few times a week may be authorized for a short term only while under supervision of the skilled healthcare professional.  However let's be very clear that your loved one's health status must explicitly dictate skilled home health visits that Medicare deems are allowable medical expenses.

Many families presume that their folks are eligible for some homecare reimbursement through a Medicare supplemental insurance plan known as a Medigap policy. Or perhaps your parents carry a secondary private health Insurance policy such as BCBS, Aetna, or Humana that you expect to pick up home care expenses where Medicare falls short. Regrettably the answer is NO. Both supplemental and secondary insurance policies do not reimburse home care costs when Medicare excludes coverage. Medicare is always considered your elderly parent's primary health insurance and sets the standard for coverage by which the other insurance policies must follow.

So you may ask who pays for in-homecare now that you realize Medicare and other supplemental policies do not. For the most part in-home care for aging loved ones is privately paid for out of pocket by families. Most families elect to pool their resources to hire caregivers and learn tactics to stretch their dollars to make homecare affordable. Scheduling caregivers to cover limited but critical times each day, avoiding the hiring of over-qualified more costly caregivers, and comparing local agency rates are just a few ideas. Refer to this article How to Afford Private Homecare for the Elderly to learn creative cost-cutting strategies to tackle this difficult endeavor.

Families who are fortunate to have parents with Long-term care insurance will find these policies reimburse for most or at least a portion of in-home care. While the plans vary greatly most do offer a significant amount of coverage and all require a licensed homecare agency to render services. Most policies reimburse for skilled nursing and rehab services in addition to custodial care for help with activities of daily living such as personal care, meal preparation and medication reminders. Consider Long Term Care Insurance?

Families may be compensated by the Family Caregiver Support Program to enable family members to care for their loved ones at home.The Family Caregiver Support Program (FCSP) was enacted by the federal government in 2000 however sadly suffered severe budget cut backs at the state level in the last decade limiting funding severely. Programs within the fifty states vary widely as to what if any programs exist yet worthy of further scrutiny by families in search of any possible means of compensation. State units on aging with assistance of local Area Agencies on Aging (AAAs) are the institutes who oversee these strictly regulated family caregiving services.

Families with limited finances and /or big medical expenses may find it worth investigating their parent's eligibility for Medicaid. Medicaid will cover a substantial amount of home care services but limitations vary from state to state. Medicaid reimburses for home care services through what are known as Home and Community-Based Services (HCBS) "waiver" programs. Eligibility for the Medicaid programs is twofold based on financial requirements and the need for care. Unlike Medicare, the Medicaid home care programs reimburse for non-medical services that are in great demand to assist folks with basic activities of daily living.

Families who have one or both parents that are veterans or spouses of veterans may be eligible to receive in-homecare benefits. The Veteran Aid and Attendance benefit provides money to those who need assistance performing everyday tasks. The benefit is in the form of an extra monthly pension designated to cover the costs of in-home care. The veteran does not have to have service-related disabilities to qualify and surviving spouses are eligible.

You are not alone if your family finds itself in this desperate time of need with few places to turn for funding home care expenses. Numerous families are confronted with the shocking and disturbing revelation that Medicare as well as Medigap and secondary private healthcare plans such as BC/BS will not pay for homecare. Frequently families must resort to privately pay for home care when there are no other available reimbursement sources. Self-pay can be draining on a family's budget and more often than not simply not feasible. Therefore be sure to exhaust all other reimbursement sources including those fore-mentioned to ascertain if applicable to your parent's situation. Adopt tactical measures to help offset homecare expenses in order to accommodate your parent's wishes to remain home and age in place.

Clare Absher RN BSN

About the Author

Clare Absher is a Registered Nurse with 44 years of experience. Most of her experience is in home health serving as a caregiver, educator, patient advocate, and liaison between families and community resources. She has also worked in acute care, assisted living, and retirement settings. She is passionate about helping families care for their elderly loved ones at home.

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