Can Medicare Help?

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A question frequently asked by family caregivers is this: does Medicare pay for home care services? A common misconception is that, once an individual turns 65, they are automatically covered by Medicare and ALL their medical needs are paid for through one of their Medicare plans. This is not true in most cases, but each individual’s needs must be weighed separately in order to determine whether benefits are available.

The Medicare program was originally created in 1965 to assist individuals 65 and older with hospital costs and basic medical care. Signed into law by President Lyndon B. Johnson, the program was originally created to provide good medical insurance for the elderly population 65 and older who could not find good insurance once they had retired. 

Over the years Congress has expanded Medicare to include coverage for disabled individuals under the age of 65, those with end-stage renal disease, and those 65 and older who select Medicare. Today the program also covers some aspects of home care when home is used as an alternative to a rehab facility. When personal care services are needed at home in conjuction with rehabilitation or recovery, Medicare may be an option.

Think of it this way: Medicare services cover the 3 R’s: recuperation, rehabilitation, or restoration. Medicare is usually a short-term intervention step, paying for services like a hospitalization after a fall or prescribed rehabilitative visits to prevent the fall in the first place. 

It’s a complicated issue, and not easily understood by many. Chris and I won’t try to explain all the ins and outs of Medicare here, but it is important to understand that Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) cover some eligible home care services under certain circumstances. The need for help must be intermittent or occasional, and services are usually coordinated by a home care agency working with under a doctor’s orders. If your loved one needs care most or all of the time, Medicare is not the solution you seek. For more details on covered services and those that are excluded, visit www.medicare.gov

Chris and I hope you’ll join us this week here at Heart of the Caregiver and share your heart about how Medicare can be of benefit to your aging family members.

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