Determining which state or federal agency helps pay for non-medical in home care can be like stepping into a thicket. Some research into Medicare and Medicaid, agencies organized and administrated by both state and federal governments makes the differences clear.
This overview helps provides orientation before you dive into the in-depth and somewhat dry websites both agencies provide.
Medicare DOES NOT COVER In Home NON-MEDICAL CARE
All Americans can get Medicare if they are over 65 or suffer from mental illness, renal failure or a few other issues. Those over 65 without a Medicare card need to call their state Medicare office to get one. Medicare even pays many healthcare costs for seniors with significant assets.
Medicare pays for in home MEDICAL care or medically-related care like part-time skilled nursing or physical, speech, or occupational therapy, but all of these must result from an illness or injury. Further, to qualify, the family must submit:
- A doctor’s prescription.
- Proof of Medicare approval of the nursing or other service.
- Proof that the senior is confined to their home by the injury, illness, or medical condition. (Medicare excuses trips to the barber, church and other necessary trips.)
- A healthcare plan provided by healthcare team, including the doctor and home medical services company. This includes injections (or helping the client self-inject), observation and assessment of a patient’s condition, catheter changes, wound care, management and oversight of healthcare plan.
Medicare DOES NOT cover:
- Personal care services like help with toileting, bathing and dressing.
- Occupational or physical therapy for issues other than serious issues.
- Meal delivery to the home.
- Shopping, cleaning, laundry.
- Assisted living facilities.
- Medical appointment transportation.
- Routine dental, eye and hearing exams.
Arranging In Home Medical Services through Medicare
Hospitals where the senior gets treatment are good about helping to organize the in homecare services that support the senior, the nurse and other healthcare provider. While the hospital staff may recommend specific agencies, the senior is free to choose their favorite, as long as the service is Medicare accredited. Family members can also call home care services agencies to learn whether and how they bill through Medicare.
Who and What Medicaid Covers
ONLY Medicaid pays for NON-medical in home care and ONLY for low-income seniors. Most seniors pay for these services from their own funds.
Medicaid pays for some or all of the expenses for daily care from in home caregivers or assisted living facilities, but the extent varies from state to state. Contact your State Medicaid office to determine services available.
Love 2 Live Care Services Knows the Ins and Outs of Medicare vs. Medicaid
No matter how complex the situation, our staff can probably help you determine which benefits you or a loved one qualifies for. When we come to talk to you about your needs during your free, no-obligation in-home assessment, you can explain your situation and how far you’ve gotten qualifying for Medicaid. Questions? Don’t hesitate to call us at 619-291-4663 today!