Senior Health Care: What You Need to Know About Medicare Coverage


i-aging
If you or your loved one is like most adults age sixty-five and older, they probably enjoy Medicare coverage. In order to qualify for this national health insurance program, you must have worked for a certain length of time, known as “quarters,” and paid into the health care system. There are exceptions, such as younger people with disabilities or individuals with end-stage renal disease. These individuals may qualify without meeting the work mandate. However, for the most part, Medicare is the health insurance of choice for elderly adults in the United States.
Unfortunately, myths abound regarding what Medicare covers and what it does not. If you’re considering health services at home, it’s important to know exactly what coverage includes. Otherwise, you or your loved one could be looking at a hefty, unexpected bill that you may not be able to afford.

Skilled home care

The good news is that Medicare coverage includes one of the most expensive and common services seniors need: skilled care at home. These services fall under Medicare Part B: the medical insurance portion (Part A is for hospital services). Skilled home care includes things like nursing (IV infusion, wound dressing, et cetera), physical, occupational, speech therapy, and social services.
These are services that only someone with a high level of education and training can perform, such as a licensed professional. However, Medicare only covers such services on an intermittent or short-term basis. In other words, Medicare will not continue to pay for them long-term or indefinitely.
Besides the age requirement, there are other criteria you must meet in order to be considered eligible for skilled services under Medicare. First, the services must be ordered by a physician and you must be under a plan of care that is regularly reviewed by him or her. Second, you must receive the services from a Medicare-certified home health agency (who will usually coordinate them for you with your doctor). Finally, you must be considered “homebound,” although you can still leave your home to attend adult day care, as well as certain non-medical functions, such as religious services.
These aren’t the only conditions that apply when it comes to Medicare coverage of skilled services; be sure to check with your provider about your portion of the payment responsibilities.

Custodial care

Now for the not-so-good news: unfortunately, Medicare doesn’t cover another common need the elderly have: custodial care. Custodial care includes non-medical services, such as assistance with ADL’s (Activities of Daily Living), such as bathing, feeding, visiting the restroom, and the like. Custodial care can also consist of things like help with meals or housekeeping – even if the senior is physically or mentally incapable of doing these things themselves.
Because this type of care can be performed by someone with a lesser degree of training (like a certified home health aide as opposed to a licensed nurse), it’s not considered a medical necessity. This means that if you or your elderly loved one has a specific physical condition, general frailty, or mental incapacity that precludes self-care, you may have to look into other coverage options.

Options besides Medicare coverage

All isn’t lost if you or your family member has custodial needs, but lacks the private funds to pay for them. Medicaid, another federally-funded health insurance program, will pay for custodial care for the elderly at home. Again, certain criterion needs to be met in order to qualify for a) Medicaid, and b) the home care portion, so remember to check with your provider. There are also private insurance options that may reduce the cost of custodial care, but this differs with the individual company.

A good home health agency can explain your options

A qualified home health agency is experienced in the various coverage options when it comes to skilled versus custodial care. Talk to one today to see how you or your loved one’s needs can be funded. This way, you can shift the focus from worrying about medical bills to functioning well and feeling your best!
If you are unsure of how to best help an aging loved one, the trained and compassionate staff at the Institute on Aging is here to help you make that decision and gain the best in at-home senior care. Contact us to find out more.

Institute on Aging

Institute on Aging

Related Posts

Questions?

Give our dedicated Client Service Specialists a call. We are ready to help.

Follow Us

As we approach the end of #SocialWorkMonth, Institute on Aging would like to take a moment to recognize and celebrate the incredible work being done by all of our Community Living Fund and HomeSafe social workers.

These dedicated professionals have shown unwavering commitment to providing exceptional care to clients and building strong, vibrant communities. We are consistently impressed by the passion and expertise they bring to their work and their ability to connect with clients in meaningful ways. Our CLF and HomeSafe social workers have risen to this challenge time and time again, going above and beyond to support the individuals and families they serve.

At Institute on Aging, we are grateful every day for our social work teams' hard work and dedication. We want to extend our heartfelt thanks to these outstanding professionals for all they do to make a difference in our clients' and communities' lives. You truly embody the spirit of social work, and we are honored to have you as part of our team.

#ThankYou #SocialWork #Appreciation #SocialWorkers #Gratitude #SocialWorkerAppreciation
Sophia became a part of the Community Living Fund team in December 2022, joining at a critical time when additional coverage was required for certain cases. Additionally, CLF was in the process of introducing a new assessment and implementing CalAim services for San Francisco members.

Sophia has been an essential contributor to these ongoing initiatives while effectively managing a caseload of Intensive Case Management (ICM) clients. We were thrilled to receive positive feedback about her support for the TRCS program, which demonstrates her dedication to the agency's mission. CLF is grateful to have a Case Manager like Sophia, who is passionate about serving San Francisco's vulnerable population.

#SocialWorkMonth #WeAppreciateyou #ThankYou #SupportatHome #CaseManager #SocialWorkerAppreciation
Three and a half years ago, Maggie Fang started her journey as an Assessment Specialist in the Support at Home Program at IOA. Her excellent people skills enabled her to manage a caseload of older adults and individuals with disabilities, helping them receive homecare to age in place. Maggie was selected to pioneer the Temporary Respite Caregiver Support program, and we are delighted to have such a skilled and dedicated individual leading our newest program at IOA. Thank you, Maggie, for your exceptional work! 

#SocialWorkMonth #WeAppreciateyou #ThankYou #SupportatHome #CaseManager #SocialWorkerAppreciation
Join us at the Adult Day Program at the Enrichment Center as Caregiver Coach Alex shares with us the incredible support and care provided to participants living with dementia. Clients enjoy various engaging activities, from music therapy to art classes, designed to stimulate their cognitive and physical abilities. The skilled staff at the Enrichment Center also provides caregivers with much-needed support and respite, allowing them to take a break and attend to their needs. If you or someone you know is looking for support in caring for a loved one with dementia, the Adult Day Program at the Enrichment Center in the Presidio is an excellent resource for you! 

Learn more by visiting the link in our bio! 

#DementiaCare #EnrichmentCenter #AdultDayProgram #CaregiverSupport #Presidio #Dementia #Memory #Caregiver