Home care helps seniors and other adults maintain their independence and remain at home as long as possible. Whether you need home care for yourself or a loved one, it's vital to understand payment options to secure the right support.
Medicare, the nation's health insurance program for seniors and people with disabilities, is one possible source of financial assistance. Let's dive deeper into this option and one of its offshoots, Medicare Advantage home health care coverage.
What Is Medicare Advantage?
People who are eligible for Medicare can choose to get their benefits in one of two ways: through Original Medicare, the traditional program run by the government, or through a Medicare Advantage plan sold by a health insurance company, such as United Healthcare, Humana and many others.
Medicare Advantage plans are required to cover the same Part A (hospital insurance) and Part B (medical insurance) services as Original Medicare. Most plans also include Part D (Medicare drug coverage).
These plans are increasingly popular because they often include extra benefits—known as supplemental benefits—that are not part of Original Medicare, such as dental care, vision care, hearing care and even home care (in-home support services). You may see Medicare Advantage home care benefits referred to as "in-home support services" in your plan's list of supplemental benefits.
Understanding In-Home Support Services
When you review Medicare Advantage plan coverage details, you may notice some cover in-home support services, or IHSS, that can include:
- Light housekeeping
- Meal planning and cooking
- Help with shopping
- Coordinating transportation
- Companionship
- Help with dressing or grooming
- Help with bathing or toileting
In-Home Support Services vs. Home Health Care
Because both in-home support services and home health care are provided at home, it's easy to get them confused. The main difference is home health care involves skilled medical care provided by health care professionals while in-home support services involve non-medical care provided by caregivers.
"The two types of care often complement each other," says Angela Gray, MBA, BSN, RN, CNML, Director of Clinical Operations and Quality at BrightStar Care®. "Our nurses and caregivers work together to provide each client with the type of care they need and can shift to accommodate a client's changing health conditions."
How to Know if Medicare Advantage Will Cover Your In-Home Support Services
To find out if Medicare Advantage will cover in-home support services, review your plan details or speak with your health plan or benefits specialist or customer service. Confirm that your plan covers the specific services you need, and be sure you understand the limitations or exclusions that affect your coverage.
Covered Services
All Medicare Advantage plans are required to cover the same home health benefits as Original Medicare, including part-time skilled nursing care and physical therapy. However, coverage for in-home support services varies depending on your plan. Plans offering IHSS will typically provide a set number of hours each year. If you don't use them, you lose them. They will not roll over to the next year.
About 1 in 10 Medicare Advantage members are in a plan that covers in-home support services, according to a Kaiser Family Foundation analysis. But among those plans, covered services vary. Check your plan's summary of benefits and coverage to find out which, if any, home care services are covered.
Limitations or Exclusions
Different Medicare Advantage plans have different rules about how you get covered services. Review the plan documents to learn about the rules that apply to at-home care, which could include:
- Network Restrictions: You may need to choose a provider that contracts with your plan ("in-network") to be covered.
- Prior Authorization: You may need to get approval from your plan before moving ahead with at-home care.
- Coverage Limits: In-home support services are often covered up to a set number of hours per year, and unused hours don't carry over.
- Deductibles: Coverage might not kick in until you spend a certain amount of money out of pocket (your deductible).
- Copayment/Coinsurance: This is a set fee or percentage you're responsible for paying when you get services.
- Excluded Services: These services are not covered by the plan.
Medicare Advantage in-home support services coverage helps eligible people receive the supportive home care services they need in the comfort of their homes. For more information, consult your Medicare Advantage health plan or speak with a BrightStar Care® representative.
BrightStar Care® Is Here to Help
BrightStar Care® offers a variety of high-quality services, from companionship to skilled nursing care. Whether you're looking for supportive home care for yourself or your loved one or a reliable medical staffing partner for your organization, our experienced local care team members are ready to help. Find a location near you, contact us online or call (866) 618-7827 to learn more about how BrightStar Care® offers A Higher Standard®.