What Home Care Is Covered By Medicare?

What home care is covered by Medicare
Is there any financial help for caregivers?

Starting home care is often a challenging time for both the patient and the caregiver. Factoring in the financial component and what’s covered and by whom can make a stressful situation even harder. 

Home care services are a valuable Medicare benefit. They supply therapy, skilled medical care and other assistance to people that are who are largely or entirely confined to their homes.

In order to be covered, the services must be ordered by a doctor, and one of the 11,000 home health agencies nationwide that Medicare has certified must provide the care. If these conditions are met, Medicare pays the complete cost of home health care up to 60 days at a time. 

That period is renewable, meaning Medicare will still provide coverage if your doctor recertifies a minimum of once every 60 days that the house services remain medically necessary.

The specific conditions enrollees must meet for home care under Medicare Parts A and B are: 

  • A doctor has certified that the person is homebound.
  • The patient is under the care of a doctor who reviews his or her treatment plan regularly.
  • A doctor has certified that the patient needs skilled medical care or some sort of therapy.
  • The patient only needs physical, speech, or physical therapy for a limited amount of time
  • The home health agency to provide care is approved by Medicare.
  • Additionally, other than durable medical aid, patients usually don’t pay anything for in-home care.
  • The need for skilled nursing is merely part-time or intermittent.

There are several items Medicare won’t cover, including:

  • Meals delivered to your home
  • Homemaker services (like shopping, cleaning, and laundry), when these are the only types of services needed
  • Personal or custodial care (like bathing, dressing, or using the bathroom), when these are the only types of services needed
  • 24-hour-a-day home care

Many patients may require assistance with activities of daily living but might not have an actual medical condition. While Medicare doesn’t cover that scenario, a long-term care policy can help with the expense of home health aides who provide custodial services. It can also help pay for assisted living facilities, which offer seniors the ability to live independently but receive the help and care they need daily.

Is there any financial help for caregivers?

According to a 2016 AARP study, they estimate that family caregivers spend a mean of $6,954 on out-of-pocket costs for caregiving, which equates to approximately 20% of their annual income. In order to cover the out-of-pocket expenses, many caregivers make sacrifices in their own lives. 

Overall the study found that caregiving puts a financial strain on individuals caring for an adult family member:

  • On average, caregivers lose 33% of their income
  • Approximately 11% of caregivers quit working to provide care for a loved one full-time
  • Women who quit working to become caregivers lose approximately a total of $300,000 in wages, pensions, and Social Security benefits
  • 78% of caregivers incur out-of-pocket costs due to caregiving
  • 56% of employed caregivers experience at least one work-related strain, in the form of reduced hours, different work hours, or taking paid or unpaid time off
  • 16% of caregivers reduce contributions to their retirement savings
  • Approximately 50% of caregivers reduce leisure spending (dining out or vacations) due to caregiving expenses

Fortunately, there are several options for finical aid for caregivers. 

  • Medicaid – Aid may be available from the state for elderly loved ones who are low-income and eligible for Medicaid. To learn about the financial aid programs available in your state, contact your local Medicaid office.
  • Long-Term Care Insurance – this is another financial aid option for caregivers. However, it is important to note that only a few such policies allow for family caregiver payments. Older policies tend to have such a provision, so it is more likely that older seniors who have long-term care insurance have policies that will pay family caregivers. It is a good idea to contact the insurance company or agent who sold the policy to determine whether the plan allows for caregiver payments.
  • Veteran-Directed Home and Community-Based Services Program – This program provides caregiver support and authorizes a monthly flexible spending account for purchasing goods and securing services for disabled veterans to live at home. Veterans who opt for this program may hire family to act as their caregivers or to provide support to family caregivers. 
  • Tax Incentives – Caregivers also may find some financial assistance via tax incentives. Caregivers who are adult children younger than age 65 may deduct the costs of qualified medical expenses and mileage that are greater than 10% of their adjusted gross income if they itemize their deductions. However, it is in your best interests to discuss your options with an accountant or other tax professional to determine whether taking a standard deduction makes more financial sense. There also may be other deductions caregivers can take at tax time. While tax incentives are not as immediate as financial aid, they are one way to relieve the financial burden on caregivers.
  • The Family Medical Leave Act (FMLA) – Workplace benefits may be available to caregivers as a form of financial aid as well. The Family Medical Leave Act (FMLA) ensures employees working for any company with more than 50 employees and who have been employed for 12 months (working a minimum of 1,250 hours during that period) are offered 12 weeks of leave; however, the leave overwhelmingly is unpaid. 
  • Paid Leave for Caregiving Employees – If you don’t live in one of the four states that have implemented paid family leave options, don’t get discouraged yet. Fortunately, more companies are assisting caregiving employees today with paid leave, and larger companies are most likely to offer elder care programs. 
  • Family Payments – If the care recipient is ineligible for Medicaid or another state program, and the tax breaks are not as large as you need them to be to compensate you for your caregiving time and related out-of-pocket expenses, look into whether he can afford to pay you himself or if other family members are willing to pay you for your caregiving services.. However, this is a subject that should be discussed openly with all involved family members and any arrangement should be agreed upon by all parties. If your family determines that family payments are manageable, be sure to meet with an attorney and draft a contract that outlines your work and payment schedule so everyone in the family knows the situation. The contract also may become useful later if your loved one eventually needs to apply for Medicaid or enter an assisted living facility or nursing home.
  • Home and Community-Based Services Program – Care recipients who are not veterans can opt into a home and community-based services program (HCBS) if they meet the eligibility criteria (which varies by state, but is typically based on income and a qualifying medical condition, though recipients need not be age 65 or older to qualify). These programs offer guidance and financial assistance to caregivers to ensure they can provide the best possible care for their loved ones. They can also boost caregivers’ confidence and make it easier for them to provide a high level of care to their family member.

Last updated Jan 23, 2020. Information subject to change without notice. Due diligence is required.

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