Medicaid vs Medicare

Covering Home Care With The Assistance Of Medicaid or Medicare

Many Americans will require some form of skilled assistance at some point in their geriatric years. This might be to provide care following a hospitalization, or it could be due to an illness or injury that makes it difficult for the individual to safely perform activities of daily living (ADLs) independently. When such care is needed, many prefer in home care so they may continue to enjoy the comforts and conveniences of their homes while rehabilitating or aging in place.

When it comes to considering home care options, one of the concerns often expressed is how to pay for these services. While private pay is an option for some, it can quickly diminish even a generously sized budget, making it difficult to continue receiving care for an extended period of time. This is why many look to insurance plans for assistance with payment for home care.

Medicare and Medicaid

Two programs that can assist in paying for home care are Medicare and Medicaid, which are both government run health programs. Medicaid is a state run program meant to assist individuals in lower income brackets with necessary medical costs. Individuals of all ages qualify for Medicaid assistance, and there is typically little or no co-pay involved when receiving benefits. Because Medicaid is state run, benefits vary from state to state, meaning coverage offered to assist with home care needs varies greatly from state to state.

Medicare, on the other hand, is a federal insurance program paid for through a trust that qualified individuals have paid toward. The primary recipients are those over the age of sixty five, dialysis patients and disabled younger adults. Individuals pay a small monthly fee to retain benefits, and they are also responsible for some co-pays.

Do Medicaid and Medicare Cover In-Home Care?

In most states, Medicaid and Medicare will pay for some home care costs if skilled nursing care is involved, the individual is home bound and she has a physician approved plan of care. For instance, if an individual requires tube feeding, catheter changes or physical therapy following hospitalization, Medicare will typically assist with the costs for some period of time. If an individual only needs assistance with ADLs, that individual will not qualify for Medicare coverage. However, assistance with activities of daily living can be covered if the individual also requires skilled nursing care or physical therapy. In addition, Medicare typically will not cover full time maid services, transportation assistance or meal preparation services unless they are combined with doctor prescribed skilled nursing services. Medicaid coverage typically mimics those provided through Medicare reimbursement, but because each state has different rules and limitations, individuals who receive Medicaid assistance should contact their local Social Services office to fully understand their coverage requirements and allotments.

Final Thoughts

While both Medicare and Medicaid will cover some home care, it is important to remember that not all services will be fully paid for through these program. Sometimes it is necessary to plan in advance and develop payment strategies so that care needs can be adequately met. For more information, individuals should contact a licensed home care to fully discuss their options.

More Resources

Official Medicaid Website

Official Medicare Website