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AARP,
January 22, 2018
En español
| Can I get financial help to pay for in-home care for my loved one?
Answer: In some instances, for some services, in some states.
Medicare
·
Medicare
qualifications for home health care are specific. Check coverage to see if your family member’s needs are
covered.
·
Personal
services. If your family member
needs only assistance with personal services — such as bathing, feeding,
dressing or homemaker services — or requires round-the-clock service, Medicare
will not cover the cost of an aide.
·
Short-term
care. If your loved one is
convalescing from an injury or illness and expected to return to previous
health, meets eligibility criteria and has a doctor-created plan of care, and
the services are reasonable and necessary for treatment of an injury or
illness.
Long-Term Care
Through Medicare and Medicaid
Program of All-inclusive Care for the Elderly (PACE) is for
Medicare and Medicaid enrollees who need nursing home-level care and want to
remain living at home. They can receive high-level in-home care. Participants
are treated by a PACE te`am of doctors and providers in their state. PACE
covers all care and services covered by Medicare and Medicaid with no
deductible or copayment for any prescribed drug, service or care — including an
in-home caregiver, skilled nursing and hospice ordered by the patient's PACE
health care team.
To qualify, your family member must:
·
Be enrolled in
Medicaid or Medicare
·
Be 55 or older
·
Need nursing
home-level care, as certified by your state
·
Able to live safely in
the community with help from PACE
·
Live in a PACE service area in the United States or certain
U.S. territories (not all states have PACE)
Cost:
·
Medicare participants
pay monthly premiums for Medicare Part D and for the PACE long-term care
portion of the benefit, but do not have deductibles or copayments.
·
Medicare or Medicaid
participants pay no monthly premium for long-term care.
·
If you don't have
Medicare or Medicaid, you can pay for PACE privately.
·
What does PACE cover?
o Adult primary
day care, including doctor and recreation therapy
o Dentistry
o Emergency services
o Home care
o Hospital care
o Laboratory/X-ray services
o Meals
o Medical specialty services
o Nursing home care
o Nutritional counseling
o Occupational therapy
o Physical therapy
o Prescription drugs
o Preventive care
o Social services — including caregiver
training, support groups and respite care
o Social work counseling
o Transportation to the PACE center for
activities or medical appointments, if medically necessary
Long-Term Care
Through Medicaid
If your family member qualifies for Medicaid
and needs long-term care, Home and Community-Based Services (HCBS) may be the solution.
Issued by your state, the Medicaid waiver program was created to enable people
who need significant services to stay out of institutional facilities and
continue living at home. HCBS provides no-cost care tailored to the individual,
including assisting with daily living — such as homemaker services and personal
care — and providing transportation to medical and therapy appointments.
To qualify, your family member must:
·
Be enrolled in
Medicaid
·
Fall within the
resident’s state income and asset criteria
·
Meet the level-of-care
and functional eligibility standards
·
Have a doctor-created
plan of care
Benefits of this program depend on the state
and may include:
·
Skilled nursing
·
Personal care
·
Hospice
·
Case management
·
Adult day services
·
Adult day health care
(offers nursing and therapy)
·
Transportation to
medical care
·
Meal programs
·
Senior centers
·
Friendly visitor
programs
·
Help with shopping and
transportation
·
Help with legal
questions, bill paying or other financial matters
Don’t overlook:
·
Employer
or union coverage. If your family member
is covered through an employer or union, ask their benefits administrator if
skilled care and other health care services are covered.
·
Medigap
policy. Those who have
Original Medicare may also have a Medicare Supplement Insurance (Medigap) Policy. Some Medigap policies pay the skilled
nursing facility (SNF) coinsurance for days 21–100. Call the insurance company
and ask if Medicare SNF coinsurance is part of your plan.
·
For more information
on Medicare, call 800‐MEDICARE
(800‐633‐4227); TTY users call 877‐486‐2048.
·
Long-term
care insurance. If your loved one has
long‐term care insurance,
call the insurance company to find out if skilled or custodial care is covered.
Figuring out how you can pay for a caregiver
is important. Knowing how to hire a
caregiver that is right for your loved one is essential.
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