Recently, Medicare Advantage (also called Part C) health care coverage changed to cover some in-home care services. One goal of the change is to prevent complications from surgery or illness. Other goals are to reduce the need for emergency services and prevent a stay in the hospital.
Medicare Advantage (Part C) is a type of Medicare health plan. It is offered by private health insurance companies that contract with Medicare. These plans provide all of the benefits associated with Parts A (hospitalization) and B (outpatient services), referred to as Original Medicare, and often, though not always, Part D.
More than 20 million people opted for Medicare Advantage plans in 2018 instead of original Medicare plans. This is because original Medicare plans have limitations. Medicare Advantage plans have supplemental benefits that relate to primary care. For instance, along with coverage for surgery or injury, plans may cover corrective lenses or hearing aids.
Recently, Medicare Advantage guidelines approved by the Centers for Medicare and Medicaid Services (CMS) in October 2018 now allow more flexibility that enhance quality of life. One of the changes that took effect on
Jan. 1, 2019 is coverage for home care.
How New Medicare Advantage Changes Connect to Home Care
In the past, coverage for home health services was limited to medical therapies and skilled nursing care, and home care services would only be approved for coverage if provided by skilled nursing care. Now, some plans can help you pay for home care, such as housekeeping services, meal delivery, and aides to help with activities of daily living, such as bathing, dressing, and eating. Ride-share coverage to medical appointments and access to telehealth may also be covered.
Many of the newly covered services may be provided by a family or professional caregiver, instead of a skilled nursing provider. This benefit was designed to help people live independently in their own homes for as long as possible.
“The changes allow Medicare beneficiaries to receive benefits that will enable them to make their home safer,” said Chris Hakim, head of the Medicare Division for eHealth and eHealthMedicare. This may cover ramps for wheelchairs and hold bars. They also allow health plans to pay for services that are preventive in nature, such as healthy meals.
These changes have the potential to improve the overall health and quality of life for beneficiaries and their caregivers, though benefits are generally limited to a certain number of hours of care each year.
Medicare Advantage plans now may also pay for respite care for the first time. Respite care options that can be covered by some Medicare Advantage plans include:
- Short-term residential facilities: Many assisted living facilities, nursing homes, and hospice centers offer short-term respite care. There are typically rooms in these facilities designed for temporary stays by respite patients.
- In-home respite care: For caregivers that need a temporary break but would like their loved one to stay at home. In this case, you can hire a professional caregiver to care for your loved one while you take a break.
- Adult day care: Caregivers can schedule respite care through an adult day care on occasion or a set schedule. This is a great change of pace and scenery for the patient while giving the caregiver a temporary break.
The exact Medicare Advantage plan options you may be eligible for will vary based on the plans offered in your area. CMS reports that roughly 300 plans added one or more of the new supplemental benefits for 2019. However, the guidelines were issued late in the year after most insurers had already released their 2019 plans. CMS expects a much larger number to offer supplemental benefits in 2020.
If you need support caring for a loved one, call us. Our trained caregivers can provide support to fit your schedule and provide you with peace of mind. We understand aging and we can help your loved one age in a healthy manner.
Caregivers at Home Care Assistance are available for daily and hourly respite care for your loved one, so you can focus on yourself and protect your health.
Contact Amanda Butas, Certified Dementia Practicioner and your Mesa client care manager, at (480) 699-4899 to see how our caregivers can help your loved one thrive.
You also can visit us at our new office next to Bed Bath and Beyond, located on the corner of Power and McKellips roads, at 2031 N. Power Road, Suite 103.