Medicare & Medicare Advantage Coverage of In-Home Care
In most cases, when ordered by a physician, Medicare Parts A and B will pay for medically necessary services provided on a short-term basis in a home setting for people age 65 or older, younger people with certain disabilities, and people with end-stage renal disease, or amyotrophic lateral sclerosis (ALS). However, a senior who requires only nonmedical care (e.g., meal preparation, bathing assistance, housekeeping), won't qualify for Medicare coverage of these services.
It’s important to note that Medicare only pays for services provided by a home care agency that meets its quality standards. A senior with a Medicare Advantage plan may have to use a certified home health care agency that participates in their plan’s network.
Program of All-Inclusive Care for the Elderly (PACE)
Another option for qualified seniors is the Program of All-Inclusive Care for the Elderly (PACE). This Medicare program is also available to Medicaid recipients in over 30 states. Most PACE participants are eligible for both Medicare and Medicaid. However, Medicare beneficiaries who aren’t eligible for Medicaid typically pay monthly premiums but don’t pay deductibles or coinsurance for this program.
Long-term Care Insurance Benefits May Cover In-Home Care
If you have long-term care insurance purchased from a private company, your benefits will likely cover the costs associated with nursing home care, assisted living, and home health care. However, coverage may vary, so it’s important to verify the benefits of your policy at the time of purchase. Keep in mind that assistance with the costs of personal home care services may only be provided if the plan includes an allowance for nonmedical services.
VA Benefits That Cover In-Home Care
Skilled home healthcare services are covered for Veterans needing short-term care as they are moving from a hospital or nursing home back to their home. The benefit may also be used to provide continuing care to Veterans with ongoing needs.
The Skilled Home Health Care Services (SHHC), Homemaker and Home Health Aide Services (H/HHA), and Home-Based Primary Care programs are available to all Veterans who meet eligibility requirements for standard benefits, although some additional conditions may apply.
Skilled home healthcare can be used in combination with other home and community-based services, however, the care must be delivered by a community-based home health agency that has a contract with VA.
Private Pay Options For Funding In-Home Care
Many families pay out of pocket for home health or personal care and support services for their loved ones. Possible sources used to cover private pay home care expenses might include the following:
- Health Savings Accounts (HSAs)
- Real Estate
- Social Security benefits
- Individual Retirement Accounts (IRAs)
- Savings accounts
Government Assistance To Help Cover the Cost of Home Care Services
If you don't have long-term care insurance coverage and can't afford to pay out of existing financial resources, there may be government assistance available to help you cover the cost of home care services.
Help with home care bills may be available through Medicaid if the care recipient has a low income or limited assets. Medicare will also pay for home health services in some circumstances. The Department of Veterans Affairs (VA) offers home care support for former service members. Additionally, people who pay for caregiving out-of-pocket can often qualify for tax breaks.
To determine what resources are available in your area, search the federal government's Eldercare Locator to find your local Area Agency on Aging. These offices are a great resource to connect you with home healthcare options, and they’re a gateway to Medicaid, which also pays for home care services. Another resource that can help you find programs you may qualify for is the National Council on Aging's BenefitsCheckUp website.
Can I Get Paid to be a Caregiver for a Family Member?
An AARP study issued in June 2021 found that 78 percent of family caregivers regularly incur out-of-pocket costs caring for a loved one, with the average annual expenditure topping $7,200. It’s safe to say the unpaid and often expensive commitment of being a caregiver can make it difficult to make ends meet.
Have you considered whether it’s possible to get paid to be a family caregiver? The truth is, your chances of getting paid are best if you are caring for a U.S. military Veteran or for someone who is eligible for Medicaid. However, other possibilities do exist.