Should one use Medicare benefits to pay for home care before long term care insurance?

4 answers | Last updated: Nov 21, 2016
Irish rose asked...

Should one use Medicare services first to pay for in-home care, such as meal preparation and giving medication, before using long-term care insurance?

 


Expert Answers

In the first place, you may not have the choice. The eligibility rules for Medicare home care are quite strict and the care is limited -- skilled nursing care, but only a very limited amount of personal care assistance. So, even if you qualify for Medicare coverage, you may need or want to use your long-term care insurance (LTCI) coverage at the same time. Also, even if you qualify for Medicare home care coverage, it won't last long.

Here's a look at eligibility for, and the extent of, Medicare home care coverage. Medicare Part A (following a minimum three-day hospital stay) or Part B (no hospital-stay requirement) can cover it if -- and only if -- you need skilled nursing or rehabilitation care at home. If you're eligible, it can include skilled nursing care, physical, speech, and occupational therapy, and medical supplies and equipment as needed while you recover from an illness, condition, or injury. Medicare does not generally provide nonmedical at-home care and assistance, including meals and housekeeping. But if you are getting Medicare coverage for skilled nursing or therapy at home, Medicare can pay for limited visits by an aide from the home care agency to help you with personal care.

For Medicare Part A or Part B to cover your at-home care, your doctor must prescribe skilled nursing care or rehabilitative physical or speech therapy. The care must be needed part-time only, to help recover from a specific illness, injury, or acute condition. If you need care because of a long-term condition or general frailty, Medicare will not cover it. Nor will Medicare cover daily care. Also, Medicare covers at-home care only if and for as long as you are "confined to home," meaning that you can't leave home without difficulty and without the assistance of another person or a medical device such as a wheelchair.

Medicare covers at-home only while you are actively recovering, which means while your condition is improving. Once your condition has stabilized, as determined by your doctor, Medicare coverage ends. Also, Medicare only covers home care provided by a Medicare-certified home healthcare agency. Unfortunately, this leaves out registry nurses, private therapists, and independent caregivers.

To get a more complete picture of Medicare coverage for home care, and for other kinds of long-term care, see the article on this site Medicare and Long-Term Care: What's Covered, What's Not.

LTCI, on the other hand, may have much easier standards to obtain home care benefits, and the benefits might cover much more extensive and more frequent care than Medicare does. So, if you are eligible for both Medicare and LTCI home care coverage, you have a decision to make. Does Medicare provide enough coverage for you for awhile? If so, you may not want to use up any of your LTCI benefits until Medicare coverage ends. On the other hand, if Medicare coverage does not provide you with enough home care to make you comfortable, you might want to start using your LTCI benefits at the same time.

 

 


Community Answers

A fellow caregiver answered...

Medicare benefits are limited for home care.  At best, they are short term.  If you are lucky enough to qualify for any Medicare services at home you should certainly use them before tapping into your LTC plan.  Many plans allow you to use medicare services during the elimination period and will also pay the "unpaid" expenses that medicare does not.   For more information, visit: www.ssltc.com  


Karen lorenzo answered...

Medicare does not pay for long term care services, they only cover skilled care but for a limited period of time only. It focus more on health care rather than custodial care (http://goo.gl/NwZxhB). So after 100 days, you are on your own. It would be wiser to get long term care insurance if you have a family health history and your finances are okay


Nicole young answered...

Although medicare may cover some home care, it only focuses on medically necessary care and not custodial in nature, thus, it does not cover homemaker services, it only covers for therapy(physical, occupational or speech), check vital signs (blood pressure, etc), coordinating your care with your primary physician. These services are only available to medicare clients as long as they are medically necessary, so once your condition improve, you no longer qualifies for home care. Other home care services like meal preparation is not covered by medicare (based on http://www.medicare.gov/coverage/home-health-services.html#2778) , but they can check the food that you eat to see if it is fit for you, as per http://www.longtermcareprimer.com/basics/ your long-term care insurance will cover this service and other custodial and personal assistance services.