Does Medicare Advantage Cover In-Home Care?

Medicare Advantage, also called Medicare Part C, is the supplemental plan that covers non-skilled in-home care. Medicare Advantage plans are an alternative to traditional Medicare (Medicare Part A and Part B), both of which don’t cover non-skilled in-home health care.

Not all Medicare Part C plans have the same coverage and benefits. Because they’re sold through independent insurance companies, rather than delivered by the federal government, some of the benefits vary by company.

Most Medicare Part C plans do cover non-skilled in-home care, including medication management, personal assistance with bathing and grooming, mobility assistance and help with catheters or colostomy bags. They also provide subscribers with postsurgical or recovery services to prevent complications and reduce the need for extended or emergency hospital stays.Medicare Part C plans vary by region, as well. Applicants are encouraged to research available plans in their area and the services offered. The Medicare Plan Finder tool assists seniors in finding plans in their state or city to fit their budget.

What Services Are Included With In-Home Health Care?

In-home health care allows seniors and those with a qualifying disability to maintain independence in their own homes. Medicare Part C plans have changed to allow some of the newly covered services to be provided by a professional caregiver or family member of the recipient’s choice. However, Medicare Part C-covered caregiver services are limited to a certain number of hours per year.

Respite Care

Some plans cover respite care, which can come in one of three forms. The first is a short-term stay in a nursing home or an assisted living facility. Many assisted living communities and hospice centers have rooms designated for short-term stay residents. Those recovering from surgery or people whose caretakers are on vacation or unable to care for their patient may benefit from this type of respite care.

In-home respite care is another option for caregivers who wish to have a break but prefer their loved one to stay at home. In these cases, professional caregiver services may be covered by the Medicare Advantage plan.

Adult day care is the third respite care option. These centers combine the social aspects of a senior center with the supervision and personal care of an assisted living facility. These care centers offer seniors the opportunity to socialize and reduce the isolation many of the elderly feel, especially those who have a health condition that makes it challenging to leave their homes.

Other Services

Other home health care services may include modifications to the home, such as ramps for wheelchair access and hold bars in the bathroom. Other options include preventative services such as paying for healthy meals and lessons in preparing nutritious meals. An emphasis on making healthier life choices to reduce the need for medication and surgeries and slowing the progression of certain diseases is part of the reason for these changes.

What Is the Eligibility for Medicare Advantage Plans?

Most people aren’t eligible for supplemental Medicare plans, or Medicare Part C, unless they’ve already been approved for traditional Medicare. Also, applicants must be under the care of a physician and receive services that are regularly reviewed by the doctor. Those applying for supplemental Medicare must also be receiving physical or occupational therapy and be certified as homebound.

Eligibility for a Medicare Advantage Plan depends on the requirements for each plan. Coverage varies according to the provider and the state. Even within a state, different areas may have different types of eligibility requirements.

For questions, call Medicare at 1-800-MEDICARE (1-800-633-4227) or TTY at 1-877-486-2048.