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Understanding Medicare Coverage for Non-Medical and Home Health Care

March 20, 2023
Kathe Kline, Founder of CertifiedMedicareAgents.com
As the aging population increases in America and the demand for quality care grows, people wonder if Medicare coverage can help provide non-medical home care. Understanding Medicare coverage for non-medical home health care is essential to provide older adults with proper care in their homes. This article will give an overview of what types of services are covered under Medicare and guidelines on how to take advantage of this critical program. Knowing your limitations and accessing resources when needed is crucial to a successful service experience. With this knowledge, we hope individuals can better understand their options and make informed decisions about their lives, especially healthcare and home care needs.

What is Non-Medical Home Health Care?

Non-Medical Home Health Care (NMHHC) is a type of health care offered to people who need assistance with activities of daily living at home. This non-medical form of care provides valuable support to elderly and disabled individuals across the country, allowing them to enjoy a better quality of life in their own homes. Home Care companies like BrightStar Care provide assistance such as:
  • Medication reminders
  • Mobility assistance
  • Dementia supervision
  • Bathing & dressing
  • Personal hygiene
  • Meal preparation
  • Companionship & socialization
  • Cognitive stimulation
  • Laundry & other light housekeeping
  • Grocery shopping & errands
  • Respite care for family caregivers
  • Assisted transportation for outings & doctors' appointments
  • and much more.

Medicare and Home Care: What is covered?

Medicare is a national health insurance program that provides coverage for elderly Americans and those with disabilities. As part of its services, Medicare offers coverage for Home Health Care. Because Home Health Care and Non-Medical Home Care sound like, confusion arises. 

Medical Home Health Care includes a range of Medical services, from skilled nursing visits to physical and occupational therapy – and can also help around the house with tasks such as dressing or bathing.
In addition, it will also cover things like hospice care and some specialized therapies like speech/language pathology and respiratory treatments. Home health agencies approved by Medicare or other organizations contracted by Medicare often provide this type of service.

Original Medicare generally does not cover the costs associated with most forms of non-medical home care or long term care.  Some Medicare Advantage Plans (Part C of Medicare which replaces Original Medicare) cover some non-medical home care.  However, most do not cover the amount of care that most people need.  For example, some plans cover 2-6 hours per week, and some cover 2-6 hours per month.  Many seniors need much more care that their Medicare Advantage Plans allow.

Many believe Original Medicare covers Non-Medical Home Care, but unfortunately, Original Medicare only covers Home Health, which is medical Home care. Home Health Care includes medically necessary care such as:
  • Physical therapy
  • Speech therapy
  • Occupational therapy
  • Wound care
  • Nutrition therapy services in limited situations 
  • Medical supplies and equipment
  • Home Physician visits
  • Skilled Nursing Care
  • Counseling

Medicare coverage may also provide medical equipment such as wheelchairs or walkers to stay at home safely and comfortably; however, you should check with your doctor's office before making any purchases to ensure they meet your specific needs. Additionally, Medicare may cover many specialized therapies but be sure you check before purchasing so that you don't end up paying out more than necessary later on.
Also, be aware that senior housing facilities are also not covered by Medicare.

How to pay for Non-Medical Home Care
Since Medicare doesn't pay for very much Non-Medical Home Care yet, how do you pay for it? There are a number of ways to pay.
  • Your savings and investments
Many people do not plan for Long Term Care expenses. Those that do will be much more likely to be able to afford the care they need.
  • Your income from Social Security or Pensions
Some people have income from Social Security and Pensions that can help cover home care costs.
  • Long-Term Care Insurance
If you've been lucky enough to plan and purchase a Long-Term Care policy, you can look at the coverage to see if it covers home care. Many LTC plans cover home care because it usually is much less expensive than moving into an assisted living community or memory care facility.
  • Some life insurance plans have Long Term Care Riders.
Check your policy to see if your permanent life insurance policy has a rider to help cover your long-term care expenses.
  • Some annuities have Long Term Care Riders.
Some annuities come with a Long-Term Care rider which either expands the benefits of the annuity or allows you to withdraw money to cover Long-Term Care expenses.
  • Aid and Attendance from the Veteran's Administration
The Aid and Attendance program covers certain veterans and their spouses. It offers a monthly cash benefit to help cover long-term care expenses.
  • Reverse Mortgages
You can take out a reverse mortgage to help cover Long Term Care expenses, and you won't have to pay the money back as long as you remain in your home.
  • Medicaid (called MediCal in California)
Medicaid can help pay for Long Term Care costs. Each state has different rules, so be sure and work with a qualified professional who understands your state program.

Conclusion
When you understand the types of services covered by Medicare and what expenses are not, you can more easily decide how to pay for your future or current home care needs. 

It also allows families to plan and ensure they have access to care if a loved one becomes sick or disabled. Non-medical home health care supports and assists with daily activities like bathing, dressing, cooking, cleaning, shopping, and errands so seniors can remain independent. You can plan to pay for these needed services with the correct information.
For more information on Medicare, find a Certified Medicare Agent near you by going to https://CertifiedMedicareAgents.com and searching your state.