IBM Medicare Via Benefits Medicare Home Care Coverage

There is a great deal of confusion about Medicare home care coverage. It's one of the top reasons why people ask for help with Medicare. It is compounded by Medicare Advantage plans sometimes offering benefits not available to Original (Traditional) Medicare policy holders.  It makes no sense to not have benefits be exactly the same. Unfortunately, that's a political problem that is difficult to solve. Just realize, when you "get" coverage (such as bathroom equipment) in a Medicare Advantage plan, you "lose" coverage (such as access to doctors nationwide) in Original Medicare. However, no matter what type of Medicare insurance you have, the fundamental principles of home care coverage are the same. 

   

It's simple. Medicare does not cover long term custodial care.  That means: Medicare does not cover the cost of hiring someone to come into your home to feed you, dress you, clean for you or do other chores, such as food shopping.  There is insurance available to cover those services but it is very expensive if your income is above the federal poverty limit.  Long term care insurance might provide some custodial care coverage. If you don't have LTC insurance, you have to pay out of pocket for that kind of help. On the other end of the spectrum, for federal poverty level income people without assets, Medicaid provides custodial care. Qualifying for Medicaid differs from state to state as do the services provided by Medicaid. 

     

Medicare does cover short term care which primarily revolves around a home bound patient needing medical assistance to recover from a medical problem.  The following brochure is provided by Medicare and details home care coverage for both Original Medical and Medicare Advantage.  It is very comprehensive: 

https://www.medicare.gov/Pubs/pdf/10969-medicare-and-home-health-care.pdf

      

All too often, people don't pre-plan actions should they need custodial care. Typically, the need arises as a "surprise" and is the worse time to figure it out. At a minimum, be informed about what is or is not covered by Medicare, Medicaid and long term care insurance and educate your family too.  Identify organizations available in your state that can help your family if you do need such care. On the other side of the spectrum, don't be pushed into unwarranted long term custodial care when the medical problem is temporary and can be remedied with Medicare home care coverage. 

Also, tell your family about home care benefits available from IBM I described in February 2020:   https://ibmmedicare.blogspot.com/2020/02/ibm-medicare-via-benefits-ibm.html