When you become eligible for Medicare at age 65, you have the option to enroll in government administered health care. What does Medicare Cover? Medicare covers a lot of your healthcare expenses, but it doesn’t cover everything. Some of the most common questions about Medicare include:
- Does Medicare cover assisted living?
- Does Medicare cover home health care?
These are services that many older adults need or will eventually need. Here’s what Medicare covers and doesn’t cover when it comes to assisted living and home health care.
Does Medicare Pay for Assisted Living?
Medicare does not cover the cost of long term residence in an assisted living facility. Assisted living is designed for people who need minimal assistance with daily living, but who cannot safely live independently. It is not considered to be a medical need that Medicare would cover. Assisted living is not the same as nursing home care, which may be covered by Medicare on a short term basis, such as recovery from a hospitalization.
What Medicare does cover is your medical expenses that arise from any medical care you receive while you are in an assisted living facility. Whatever services are covered by the Medicare plans you are enrolled in will still be covered wherever you live. Medicare does not cover the cost of the assisted living facility itself.
Does Medicare Pay for Home Health Care?
Medicare does cover home health care under specific qualifications. Medicare will cover home health care if:
1. You are homebound, meaning it is extremely difficult for you to leave your home and you need help doing so.
2. You need skilled nursing services and/or skilled therapy care on an intermittent basis.
- Intermittent means you need care at least once every 60 days and at most once a day for up to three weeks. This period can be longer if you need more care, but your care needs must be predictable and finite.
- Medicare defines skilled care as care that must be performed by a skilled professional, or under their supervision.
- Skilled therapy services refer to physical, speech, and occupational therapy.
3. You have a face-to-face meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care. This can be an office visit, hospital visit, or in certain circumstances a face-to-face visit facilitated by technology (such as video conferencing).
4. Your doctor signs a home health certification confirming that you are homebound and need intermittent skilled care. The certification must also state that your doctor has approved a plan of care for you and that the face-to-face meeting requirement was met.
- Your doctor should review and certify your home health plan every 60 days. A face-to-face meeting is not required for recertification.
5. And, you receive care from a Medicare-certified home health agency (HHA).
If you do not meet these requirements, you may not be eligible for home health care coverage under traditional Medicare Part A and B.
How Can I Get Coverage for These Needs?
There are two options for getting additional coverage beyond just Medicare Part A and B:
- Medicare supplement insurance plans
- Medicare Advantage plans
Medicare supplement insurance plans, sometimes called Medigap, were designed to cover the gaps in Medicare Part A and B coverage. It covers out of pocket expenses like copays and deductibles.
Medicare Advantage plans are offered by private insurance companies to take the place of Medicare Part A and B. They offer additional coverage that traditional government provided Medicare does not cover.
Different plans cover different things, so you’ll want to discuss your needs with a reliable Medicare Insurance Provider who can recommend the best coverage for you.
Get Extra Coverage from Norgard Insurance Group
Norgard Insurance Group can help you pay for services like assisted living and home health care when your Medicare coverage doesn’t. We can help you find the right Medicare supplement insurance, Medicare Advantage plan, or other insurance coverage that will help with the expense of home health care and assisted living. These are services that many older adults need or will need at some point. Norgard Insurance Group can help you be prepared for the future.