How Do I Pay for Home Care?
This is the third of five installments in our Making Home Care Work for Your Aging Loved One series. The transition of introducing care into your aging loved one’s home can feel very overwhelming! We started by compiling five of the main concerns our customers have expressed to us. Each installment focuses on one specific obstacle and how to tackle it, based on our 30 years of home care experience. Remember: you can do this.
Concern #3: How do I pay for home care?
To answer this question as comprehensively as possible, I started with our dedicated Intake Nurse, who answers all of our incoming calls to 1-800-HOMECARE in Missouri, and 618-HOMECARE in Illinois.
Understandably, this is the most commonly asked question when potential customers call us. They also ask, “Will Medicare pay for my home care?” The answer is yes and no. There are two main types of home care, and Medicare pays for one of them if you qualify. First, let’s examine what Medicare pays for, and how to qualify for Medicare home health care services.
Medicare Home Health Care
If you are over 65 or older, you qualify for Medicare. Unfortunately, many people incorrectly think that Medicare will pay for all of their health care needs when they are older which is not true. When it comes to home health care, Medicare will only pay for skilled-type services. These are services that can only be provided by a skilled, licensed clinician like a nurse or a therapist.
If you have been hospitalized, and still have the potential to improve as you are discharged home, your doctor may prescribe a home health care assessment. Many hospitals have their own home care company but you can choose any company in St. Louis (or the county where you live) as your home care provider. Within a day of returning home, a nurse or physical therapist will come to your home to complete an assessment. This information is submitted to your doctor and he/she will approve services appropriate for your needs. For example, if you need nursing care, a nurse may visit you two or three times per week. Your home health care nurse may also educate you or a family member about how you can begin to perform your own nursing care (as appropriate). Every Medicare approval period, or “episode”, lasts up to 60 days and may be renewed if needed. If you get better sooner, or no longer need this specialized assistance, your services will be discontinued. Aside from hospitalization, other common reasons one begins receiving Medicare home health care is if they have a new diagnosis, or if their condition has suddenly declined. You can ask at any time if you qualify for Medicare home health care services; your doctor will determine if you are eligible, and the particular services for which you qualify.
Other services available during your episode(s), depending on your health care needs, may be physical therapy visits to help you regain your strength and mobility, and/a social worker to help you access community resources, and/or an occupational therapist to ensure you can perform all of your own self-care safely.
You may even qualify for a few Home Health Aide visits. Your Home Health Aide can help you bathe until you can do so on your own or with help from a trained family member. None of your clinicians can help you with ongoing safety and supervision because Medicare pays for skilled services only.
Medicare will pay 100% for the services described above if you qualify. If you need medical equipment like a walker to move around safely Medicare may only pay 80%, so you’ll have to pay the remaining 20% out-of-pocket or through a supplemental insurance if you have one.
Medicare Hospice Care
When you have traditional Medicare or a Medicare Advantage Plan, if you qualify for hospice care your policy includes hospice benefits. Many private insurances also include a hospice benefit. Medicaid also includes hospice benefits. Hospice care is appropriate when one’s illness limits their life expectancy to six months or less with normal disease progression. When hospice resources are introduced, you may feel strong emotions including shock, sadness and fear. Hospice and palliative care is designed to bring understanding, comfort and reassurance. It can help both the patient and their family throughout this very difficult experience.
Unlike Medicare, you must qualify financially for Medicaid. Another way to remember this is that Medicare is a federal program designed primarily for seniors, while Medicaid is managed state by state and is designed for individuals with very low incomes and/or disabilities. First, one must qualify financially, based on monthly income, as an individual or a family. To receive in-home services through Medicaid, one must also qualify by needing assistance with some of their activities of daily living like bathing, dressing, going to the bathroom and/or walking. There is an approval process that takes approximately 30 days from the time you apply for in-home services, until you begin receiving them. Cooperative helps clients who are new to the in-home services program as well as clients who have received these services for many years. If you are receiving Medicaid in-home services and you also qualify for Medicare, then if you are hospitalized you may receive Medicare home health care to help you regain your strength and improve as much as possible before resuming your Medicaid in-home care to maintain your current independence level at home.
The Department of Veterans Affairs pays for two main types of home care. The first is Fee-based services and the second is through the Aide and Attendance pension. If you are a veteran who was active duty status for at least one day during which our country was officially at war, you may qualify for this pension which reimburses you for part of your home care expenses.
Private Health Insurance
Your private health insurance may pay for skilled services prescribed by your physician, similar to Medicare. If you have medical insurance and Medicare, your insurance must pay before Medicare may pay any remaining portion.
Long-Term Care Insurance
One may elect to enroll as early as when he or she is in their 40s, paying a monthly premium. Policies vary greatly from the cost of monthly premiums, to the amount of paperwork required to access benefits, to approved services (including skilled care, assisted living, caregiver visits or a combination). One big challenge is to accurately choose the policy appropriate for your anticipated long term needs.
Worker’s Compensation Insurance
This insurance will pay for all of your medical needs as a result of a work-related accident or injury.
Reduced Fee Programs
Cooperative Home Care works with Jewish Family & Children’s Service as a provider for their Reduced Fee Program. Funded through the United Way and available for persons of any religious affiliation, this program helps qualified individuals “pay what they can afford” per hour for home care. One must meet financial and clinical qualifications; occasionally there is a waiting list to enroll.
After examining every other funding option: Medicare, Medicaid, VA, Medical Insurance, Long-Term Care Insurance, Worker’s Compensation and Reduced Fee Programs, clients may pay out-of-pocket for some or all of their home care services. Cooperative Home Care offers unique Value Packages to meet your home care needs as affordably as possible. Our Intake Nurse is available to help qualify you for every type of home care service before you pay out-of-pocket, when you call 1-800-HOMECARE in Missouri or 618-HOMECARE in Illinois.
Now that you have an overview of funding options, next up is Concern #4: How do I choose a home care company?
What do you think? Do you have a concern you’d like us to address? Share your thoughts on our Facebook page!