Does Medical Insurance Help With In-Home Care For The Elderly?

Planning for in-home care is not a simple consideration; there are several aspects to factor in. With the senile population of America insisting on staying in their own homes till their last breath, in-home help becomes the need of the hour at some point or the other. In-home care can be for a few hours a day or 24×7 depending on the condition of the patient.

Did you know that the population above 65 years is expected to grow from 56 million to 73 million by 2030? This implies that the need for in-home care is only likely to increase. In such a scenario, early planning to purchase insurance coverage that offers in-home care benefits would be definitely a wise step.

UNDERSTANDING MEDICARE

While some insurance providers will cover certain specific in-home care services, they may vary from one plan to another. When it comes to in-home care coverage, most insurance providers follow Medicare regulations. Therefore, it’s important to understand how Medicare works so that you can make an informed decision.

Hospital insurance covers the healthcare stays of patients in hospitals or nursing facilities or hospice care. It can cover in-home care for patients in case the receiver is home-bound or requires the assistance of a physical therapist or nurse to function. In such conditions, the patient also receives Speech Therapy, Occupational Therapy, or Home Health Aide if needed and gets insurance coverage.

But it’s worth noting these services will only be provided in addition to another care meeting to the mentioned criteria. This implies that right from the point of skilled care is not required for the patient, the insurance wouldn’t cover it anymore.

UNDERSTANDING MEDICAID

Yet another important health insurance program, Medicaid is devised to cater to the needs of the low-income group. It is jointly funded by the state and federal governments. Medicaid covers blind, disabled, and other individuals including children who are eligible for receiving federal assisted payments. In essence, Medicaid is an income-based health insurance coverage that follows the FPL or Federal Poverty Level Table for setting the income eligibility of receiving individuals.

Compared to Medicare, Medicaid is even more complex since individual states run differently based on their distinct pool of income for various classes of in-home care. Since it is jointly funded, an individual may receive Medicaid-managed care in place of Medicaid itself. The best part is that Medicaid-managed care offers an extensive and long-term service while the people administering it are in-home care providers themselves.

While Medicare will bear the cost of in-home care prescribed by healthcare professionals, it can only qualify for intermittent care which is less than 8 hours in a day for less than 7 days every week. On the other hand, assistance in bathing and other non-medical care do not qualify. The coverage for Medicaid is decided at the state level which means no set rule applies to all regions.

PAYING FOR IN-HOME CARE

With chronic health issues and recovery from illnesses like dementia or the normal process of aging taking a toll on a person’s health, opting for in-home care becomes necessary. In such situations, it is natural for families to become concerned about the costs of home care services and the financial coverage that they can avail for the same.

In the first step, it is important to understand the kind of care an individual requires. To understand this, a comprehensive need evaluation is conducted to decide the kind of services needed to meet the unique requirements of the elderly person.

As you become aware of the medical requirements of the elderly person in your family, the next step is determining the costs of in-home care. It goes without saying that the in-home care offered by trained and skilled staff like registered therapists and nurses is very expensive.

TRADITIONAL HEALTH INSURANCE PLANS PAY FOR IN-HOME CARE

Private health insurance plans are crafted to pay for selective elderly care services even though coverage plans may vary from one plan to another. In most cases, private health insurance doesn’t pay for in-home care services.

Long-term care insurance refers to a class of coverage offered by private concerns for covering the costs of assisted living, home health care, and nursing home care. The plan you opt for determines the benefits and coverage of the plan. Thus, it’s crucial to understand the services covered by the policy while purchasing. You should bear in mind that it will include the costs of personal in-home care when the plan chosen allows non-medical services.

You should plan ahead when purchasing long-term care insurance. For healthy individuals aged between 50 and 60 years, the premium is the lowest. On the other hand, very old people afflicted with an irreversible disease or serious medical issues have scant chances of qualifying for coverage. As per the reports of the American Association for Long Term Care Insurance, over 53.6 percent of people aged more than 75 didn’t qualify for traditional long-term care policies in 2019.

Veterans Health Administration VHA has a standardized medical benefits package to offer different levels of home and community-based services in place of conventional home care for older people. VA pensions give funding to cover the costs of in-home care for older needy people and their spouses. Besides that, there are certain improved’ pensions that inflate the monetary benefits of veteran citizens along with their surviving spouses who might require a higher level of care.

FINAL THOUGHTS

Research claim that around 90 percent of individuals aged over 65 years prefer living at home where they want to age gracefully in their own comfort zone. But to make it possible, additional care becomes necessary at some point or the other. As a result, many people are turning to in-home care services. An increasing number of health disorders among aging people coupled with increasing prices of medical treatment makes it almost essential to look for suitable medical insurance that offers optimum coverage. It’s important to research prospective health policies to choose the best coverage options.