Will Medicare Pay for Home Care in PA?
Most people initially enroll in Medicare near their 65th birthday when they are still physically healthy and independent. As they age, they typically find that they need more extensive coverage. During the Medicare open enrollment period every year, it’s important for seniors to take a close look at their current policies so that they can update their coverage for anticipated needs.
One such need that people may have if they are dealing with progressive diseases or physical disabilities is home care. Despite physical limitations, most people are more comfortable remaining in their own home as long as possible. This type of independence is more sustainable when the individual has a home care helper to assist with activities of daily living.
What Home Care Does Medicare Cover?
Individuals who have Original Medicare will have Medicare Part A (hospital insurance) and Part B (medical insurance) as separate policies. Medicare Advantage Plans combine these parts into a single plan. On any type of plan, a Medicare participant whose doctor certifies that home care is needed will be eligible to receive certain covered services. These services may include:
- Temporary skilled nursing care
- Physical, occupational, or speech-language therapy
- Temporary home health aide care
- Medical equipment or supplies
Typically, Original Medicare does not pay for non-medical home care assistance. Participants with a Medicare Advantage plan may have a supplemental policy for home care assistance. If the participant does not have this kind of coverage in their Medicare plan, they should explore their options during the open enrollment period from October 15 to December 7. Participants may also need to look to other types of coverage such as long-term care insurance or Medicaid.
Does Long-Term Care Insurance Cover Home Care?
Private long-term care insurance policies offer coverage for many services, such as skilled nursing, assisted living, and home care. Every policy is customized based on the participant’s budget and anticipated needs, so everyone should take time to understand their own policy.
Annual premiums for long-term care insurance are based on the participant’s age when the policy is purchased. Therefore, it is a good idea to obtain this kind of insurance prior to retirement. The annual cost of coverage can more than double every 10 years. Long-term care insurance needs to be in force before the participant requires any kind of care that would be covered by the policy.
Does Medicaid Cover Home Care?
For many individuals, home care can be covered by Medical Assistance, or Medicaid. Medicaid benefits are available to people over age 65 through the Commonwealth of Pennsylvania’s Department of
Human Services. Individuals must apply for Medicaid by phone, online, or with the assistance of their County Assistance Office. Once they are covered under Medicaid, they have access to Support Services Waivers that fund home care services.
Through these waivers, participants can remain in their own homes while receiving assistance with activities of daily living from qualified professionals. The waivers empower individuals to choose their own home care services, as long as those services are approved by Medicaid in Pennsylvania.
Obtaining Home Care in Pennsylvania
Many participants will ultimately use a combination of Medicare, private insurance, and Medicaid to cover their home care needs. Individuals and their families should use their available resources to make sure that they always have current information on covering their care needs. These resources include their insurance provider’s service coordinator, county assistance office, and local agency on aging.
At Linda’s Care, we strive to be another valuable resource for families navigating home care coverage. We routinely assist participants with the steps necessary to ensure they have access to the right level and hours of care. If you or your loved one have questions about how to initiate home care services or
make sure that your home care assistance will be covered, please contact us. If we cannot answer your questions, we will point you in the right direction or do some research to learn more. Linda’s Care provides affordable and high-quality non-medical home care services in Philadelphia, Montgomery County, Bucks County, Chester County, and Delaware County.