If you have a condition that makes you homeboundHomebound refers to a person who is unable to leave their home due to a medical condition. Homebound individuals can still leave home for brief periods for non-medical reasons such as graduation, family reunions, funerals, and..., it is simple enough to get coverage for medical services through Medicare. However, as far as Medicare is concerned, daily living activities such as cooking and getting dressed are not medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.. The unfortunate reality is that many homebound people are unable to take care of themselves without assistance.
Medicare will not cover in-home care unless it is part of a doctor-ordered treatment program. Thankfully there are other ways to pay for the cost of a caregiver to help you while you are homebound. Continue reading as we dig in and explore ways to pay for in-home care costs.
- In-home care is concerned with daily activity assistance when you cannot do it yourself, such as cleaning and feeding.
- In-home care is often confused with home health careHealth care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered..., which actually concerns medical assistance such as administering medication or treating injuries.
- Medicare will not cover in-home caregivers if it is not part of medically necessary treatment.
- MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. will help qualifying beneficiaries with in-home care services.
- If you are unable to meet Medicaid’s federal qualifications for in-home care coverage, some states have Medicaid Waivers that allow you to bypass these qualifications.
- Long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including... insurances can provide help with in-home caregiver costs if they are purchased before they are needed.
In-Home Care vs. Home Health Care
In-home care is not the same as home health care. The inclusion of “health” is what makes home health care different. With home health care, individuals receive assistance with the medical condition or injury, while home care does not provide that support. The following are what home health care offers vs. what home care offers:1Medicare.gov, “Home health services“, Accessed January 4, 2022
- Meal Preparation and Delivery
- House Cleaning
- Assistance with Bathing, Dressing, and Grooming
- Reminders to Take Medicine
- Incontinence Care
- Toileting Help
Home Health Care
- Rehabilitation Therapy
- Administers Medication
- Performs Medical Tests
- Monitors Health Status
- Reminders to Take Medicine
- Skilled Nursing
- Wound Care
- IV Therapy and Injections
Home health care is covered by both Medicare and Medicaid1Medicare.gov, “Home health services“, Accessed January 4, 2022. In-home care is covered by Medicaid2Medicaidplanningassistance.org, “Medicaid and Home Health Care & Non-Medical, In-Home Care“, Accessed January 4, 2022. If you don’t qualify for Medicaid, you must pay for in-home care out of pocket or through long-term care insurance.
How Does Medicaid Cover In-Home Care?
Medicaid is a joint federal-and-state program that provides help with medical costs for people with qualifying incomes. Medicaid is run on a state level and can help with services that Medicare either does not cover or covers partially. If the service is covered by Medicare and you are enrolled in both Medicare and Medicaid, then Medicare would provide their share first and Medicaid would cover afterward.3Medicare.gov, “Medicaid“, Accessed January 4, 2022
One of the services Medicaid provides help with is in-home care for those that need it but are unable to afford nursing home care. Medicaid covers the cost of caregivers and some states will allow you to hire relatives, such as spouses and adult children, to provide you with in-home care. Medicaid also provides in-home care coverage if you reside in a relative’s or friend’s home, adult foster care home, or assisted living facility.2Medicaidplanningassistance.org, “Medicaid and Home Health Care & Non-Medical, In-Home Care“, Accessed January 4, 2022
If you do not meet the initial qualifications for Medicaid in-home care coverage, some states allow you to apply for a Medicaid Waiver that will allow you to bypass federal requirements for coverage. This is highly dependent on what your state allows, so you would need to contact your state’s Medicaid office for further details on how to apply for a Medicaid Waiver.4Medicaidplanningassistance.org, “Home and Community-Based Services (HCBS) via Medicaid Waivers Assist Seniors in Aging at Home“, Accessed January 4, 2022
Long-Term Care Insurance
Another alternative to getting in-home care coverage is purchasing long-term care insurance. Long-term care insurances will help with the costs of an in-home caregiver and nursing home fees in the event that you are unable to care for yourself. You will need to plan ahead if you decide to get long-term care insurance, as you will not be able to apply if you already suffer from a condition that prevents self-care, such as:5OPM.gov, “LONG TERM CARE“, Accessed January 4, 2022
- Severe injury and disability
- Alzheimer’s disease
- Parkinson’s disease
- Multiple sclerosis
- Age-related muscular dystrophy
Like most insurances, you should consider it is an investment to protect your finances over the long term should the worst come about. If you are interested in learning more about the benefits of long-term care insurance, please read more about it in our article here.
While Medicare will cover your medical services when you are homebound, you have to rely on Medicaid or long-term care insurance to help with in-home care costs. If you are unsure if your income qualifies you for Medicaid, or if you want to apply for a Medicaid Waiver, you will need to State Medical Assistance (Medicaid) office for more information.
If you are having trouble finding your state’s Medicaid contact info on their website, you can also call 1-800-MEDICARE (1-800-633-4227) to get connected to your state’s Medicaid office. TTY users can call 1-877-486-2048.
- 1Medicare.gov, “Home health services“, Accessed January 4, 2022
- 2Medicaidplanningassistance.org, “Medicaid and Home Health Care & Non-Medical, In-Home Care“, Accessed January 4, 2022
- 3Medicare.gov, “Medicaid“, Accessed January 4, 2022
- 4Medicaidplanningassistance.org, “Home and Community-Based Services (HCBS) via Medicaid Waivers Assist Seniors in Aging at Home“, Accessed January 4, 2022
- 5OPM.gov, “LONG TERM CARE“, Accessed January 4, 2022