Recovering from an illness, injury or surgical procedure is difficult for anyone, but for those 65 and older, the process can be long and arduous. The choice to recover at home or at a transitional rehab center is not easy, especially for seniors who live alone and can’t count on family or friends for help.
Home health care can provide the solution for seniors who want to recuperate in the comfort and privacy of their own homes. While in-home care can be costly, Medicare and most long-term-care insurance (LTCI) plans will cover many of these expenses provided you meet certain eligibility requirements.
Medicare Home Health Care Services
According to Medicare.gov, to qualify you must:
1. Be certified as homebound by your doctor.
2. Follow a physician-directed plan of care that includes:
- The kind of care you require and what type of medical professional will provide the service, such as a nurse practitioner or physical therapist
- How frequently the services will be provided
- Supplies or medical equipment needed for your care
- The results or outcomes the doctor expects over a period of time
(This plan must be reviewed, updated, and recertified every 60 days.)
3. Have visited your doctor in person less than 90 days before or 30 days after home health services have begun.
4. Use a Medicare-certified home health agency.
What Medicare Can Cover
Medicare Parts A and B will cover part-time or intermittent skilled nursing care, physical and occupational therapy, home health aides, and other care services provided they are medically necessary and ordered by your doctors. Medicare may also cover required medical supplies such as catheters and medical equipment such as walkers and wheelchairs. Visit Home Health Services Coverage (medicare.gov) for more information.
Long-Term-Care Insurance (LTCI) Coverage
According to the American Association for Long Term Care Insurance (aaltci.org), in addition to covering care at an assisted living community or nursing home, many LTCI policies offer in-home care coverage. If you already have an LTCI plan, review it with your insurance provider to make sure it includes in-home care. Get details on the type and duration of care provided.
If the policy pays a fixed cash benefit, you can use those funds on any type of care you choose, including paying a family member or friend to tend to your in-home care needs. Your plan may also cover services such as meal preparation and housekeeping.
Keep in mind, most LTCI plans require you to pay a specific number of days (usually 90) out-of-pocket before the plan starts to pay.
The stipulations for both Medicare and LTCI plans can be confusing. Take time now when you might not need home health care to research and determine coverage so that when the time comes, you can take full advantage. Before making any decision on care options, check with a licensed insurance agent familiar with both Medicare and LTCI policy inclusions and exceptions.
By Kym Voorhees Raque | Photo by Gaelle Marcel