Does Insurance Cover In-Home Care for Elderly? How Insurance Paves the Way for Elderly In-Home Care

In-home care is a service that provides personal assistance, medical care, or both to elderly people who need help with daily activities.

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In-home care can help the elderly maintain their independence, comfort, and quality of life in their own homes.

However, in-home care can also be expensive, and many people wonder if their insurance will cover it.

In this article, we will explore the different types of in-home care, the benefits of in-home care for the elderly, and the insurance options that can help pay for it.

Types of In-Home Care

There are two main types of in-home care for the elderly: non-medical and medical.

Non-medical in-home care, also known as personal care or custodial care, provides assistance with activities of daily living (ADLs) such as bathing, dressing, grooming, eating, toileting, and transferring.

It is usually provided by home health aides, personal care aides, or companions.

Medical in-home care, also known as skilled care or home health care, provides medical services such as wound care, injections, medication management, physical therapy, occupational therapy, speech therapy, and nursing care.

It is usually provided by licensed professionals such as nurses, therapists, or home health aides under the supervision of a doctor.

In-home care can offer many benefits for the elderly, such as;

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1.Personalized care

In-home care can be tailored to the specific needs, preferences, and schedule of each individual.

The elderly can receive the level and type of care that they need, when and where they need it.

2.Comfort and familiarity

In-home care allows the elderly to stay in their own homes, surrounded by their belongings, memories, and loved ones.

This can reduce stress, anxiety, and depression, and enhance their emotional well-being.

3.Independence and dignity

In-home care can help the elderly maintain their autonomy and self-esteem, as they can continue to do the things that they enjoy and make their own decisions.

It can also respect their privacy and personal space, and avoid the stigma of institutionalization.

4.Safety and security

In-home care can reduce the risk of falls, infections, and other hazards that the elderly may face in unfamiliar or crowded environments.

It can also provide supervision, monitoring, and emergency response, ensuring that the elderly are safe and protected at all times.

5.Family involvement and support

In-home care can enable the elderly to stay close to their family and friends, who can visit them anytime and participate in their care.

It can also provide respite and relief for family caregivers, who can share the responsibility and burden of caring for their loved ones.

Insurance Options for In-Home Care

The cost of in-home care can vary depending on the type, frequency, and duration of care, as well as the location and provider of care.

According to the Genworth Cost of Care Survey 2020, the national median monthly cost of non-medical in-home care was $4,481, and the national median monthly cost of medical in-home care was $4,576.

These costs can add up quickly, and many people may not be able to afford them out of pocket.

Fortunately, there are some insurance options that can help cover some or all of the cost of in-home care, such as:

1.Medicare

Medicare is a federal health insurance program for people who are 65 or older, disabled, or have certain chronic conditions. Medicare Part A covers hospital care, skilled nursing facility care, hospice care, and some home health care.

It only covers medical in-home care that is ordered by a doctor, provided by a Medicare-certified home health agency, and deemed medically necessary and reasonable.

Medicare also has certain limitations and requirements for in-home care coverage, such as:

1.The elderly must be homebound, meaning that they have trouble leaving their home without help or that leaving their home requires a considerable and taxing effort.

2.The elderly must need skilled care on an intermittent or part-time basis, meaning that they need care for less than 8 hours a day and less than 7 days a week, or for 21 days or less.

3.The elderly must have a face-to-face visit with their doctor within 90 days before or 30 days after the start of in-home care, and have a written care plan that is regularly reviewed by their doctor.

4.The elderly must pay 20% of the Medicare-approved amount for durable medical equipment, such as wheelchairs, walkers, or oxygen tanks, that they may need for in-home care.

Medicare typically covers 100% of the Medicare-approved amount for home health services, such as skilled nursing care, physical therapy, occupational therapy, speech therapy, and home health aide services.

It also covers 80% of the Medicare-approved amount for durable medical equipment.

Medicare does not have a limit on the number of visits or the length of time that the elderly can receive in-home care, as long as they meet the eligibility criteria and their doctor renews their care plan every 60 days.

5.Medicaid

Medicaid is a joint federal and state health insurance program for people who have low income and limited resources.

Medicaid covers a wide range of health care services, including in-home care.

However, Medicaid eligibility and benefits vary by state, and each state has its own rules and regulations for in-home care coverage.

Some states may require the elderly to meet certain income, asset, and functional criteria to qualify for in-home care.

Medicaid covers both non-medical and medical in-home care, depending on the needs and preferences of the elderly.

It may cover personal care services, such as help with ADLs and IADLs, that are provided by home health aides, personal care aides, or companions.

Medicaid may also cover home health services, such as skilled nursing care, physical therapy, occupational therapy, speech therapy, and home health aide services, that are provided by licensed professionals under the supervision of a doctor.

It may also cover other services that support in-home care, such as adult day care, respite care, meal delivery, transportation, and home modifications.

The amount and duration of in-home care that Medicaid covers may vary by state, program, and provider.

Some states may have limits on the number of hours, days, or visits that the elderly can receive in-home care.

The elderly should check with their state Medicaid agency or local Area Agency on Aging to find out the specific eligibility and coverage details for in-home care in their state.

1.Long-term care insurance

Long-term care insurance is a type of private insurance that covers the cost of long-term care services.

It can also offer more flexibility and choice in the type, amount, and provider of in-home care.

Long-term care insurance policies vary in terms of the benefits, features, and costs that they offer.

The elderly should compare different policies and choose the one that best suits their needs, preferences, and budget.

Some factors that the elderly should consider when buying a long-term care insurance policy include:

2.The daily or monthly benefit amount, which is the maximum amount that the policy will pay for in-home care per day or per month.

3.The benefit period, which is the length of time that the policy will pay for in-home care, ranging from a few years to a lifetime.

4.The elimination period, which is the waiting period that the elderly must pay for in-home care out of pocket before the policy starts paying, ranging from zero to 100 days or more.

5.The inflation protection, which is the feature that increases the benefit amount over time to keep up with the rising cost of in-home care.

6.The benefit triggers, which are the conditions that the elderly must meet to qualify for in-home care benefits

7.The care coordination, which is the service that helps the elderly plan, arrange, and monitor their in-home care.

8.The premiums, which are the amount that the elderly must pay for the policy, either monthly, annually, or in a lump sum.

The cost of long-term care insurance depends on the age, health, and gender of the elderly.

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