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Does Insurance Pay for Homecare?

Someone turning 65 today has about a 70 percent chance of needing some type of long-term care in the future. About 65 percent of people receive care at home; they use this care for an average of two years. While Medicare pays for homecare for some people, others hope their insurance policies will cover the cost of in-home care so that they can recover from a serious illness or injury at home instead of in a nursing facility.

What is Homecare?

Many people need help as they age, become frail, are recovering from a serious illness or there is a risk of falling when ambulation becomes more difficult. Homecare agencies such as Connecticut In-Home Assistance can help with light housekeeping, laundry, shopping and activities of daily living such as bathing, dressing, toileting, ambulation, medication reminders, meal preparation and feeding. These activities do not require the skills of a trained nurse. Doctors refer to this as “custodial care.

Skilled care requires the attention of licensed professionals, such as nurses, physical or occupational therapists, and social workers. These professionals provide medically necessary care to help patients remain at home rather than move to a nursing home. Skilled care is usually temporary; many people require some amount of custodial care after skilled care ends.

Once skilled care insurance coverage ends, the patient may need to arrange for alternative custodial care coverage.

Does insurance pay for homecare?

Insurance coverage for care at home depends on whether the care is medically necessary or custodial in nature. Since many in-home services are custodial in nature, a private medical insurance policy may not pay for some types of homecare. Coverage varies between plans, so the holder should read his policy carefully to determine if it covers both skilled and custodial care. Many policies require pre-approval by a doctor; some do not cover general personal care.
Long-term care insurance policies help cover the cost of homecare or care in a nursing facility. These policies not only cover respite care but also protect assets in cases of lengthy illnesses.

What about Medicare?

Medicare provides home care benefits to qualifying seniors. To qualify, one must:

  •   Be homebound and under the care of a doctor and receiving regular services under a care plan reviewed by a doctor
  •   Have a physician-certified need for intermittent skilled nursing care, physical therapy, speech services, or continued occupational therapy
  •   Use a Medicare-approved homecare agency

 

Medicare bases eligibility on the amount of services an individual needs. Medicare will pay for intermittent skilled nursing care and defines “intermittent” as fewer than seven days each week or less than eight hours in a day over a period of 21 days or less.

Are there other options?

There are other options available to seniors seeking financial assistance for homecare services. Many state and locally funded programs offer limited assistance to seniors who meet certain criteria. The Veteran’s Administration has reimbursement programs that repay qualified vets or their widow for homecare services. Seniors with equity in their homes can use a reverse mortgage to pay for homecare and other necessities. A handful of exceptional in-home assistance companies provide a variety of options to fund in-home custodial and skilled home care.

For more information feel free to contact your local Department of Social Services or call Connecticut In-Home Assistance at 866-464-9035 .

Sources: https://www.metlife.com/assets/cao/mmi/publications/essentials/mmi-receiving-care-at-home.pdf http://longtermcare.gov/the-basics/how-much-care-will-you-need/ http://www.medicare.gov/Pubs/pdf/10969.pdf

Posted: September 30, 2013 under blog. Helpful Article. Comments: none