If your loved one requires care, you are probably wondering what is covered under their insurance plan and how much of their social security check will be needed to pay for medical care or homemaker services. If your parent needs specialized services such as medical supplies, physical therapy or occupational therapy; or if you need to pay for a caregiver that comes in when you can’t be there because you work part time, it can be even more important to know if original Medicare pays for some of those services or if your parent needs to sign up for Medicare Advantage plans.
As your parent ages, they will need additional prescription drugs or more than just intermittent skilled nurses from a home health agency, which can be stressful to think about how much it will cost. Look at what Medicare beneficiaries can expect in coverage, who qualifies as a caregiver (Part A caregiver under Medicare rules), what the Medicaid Self-Directed Care Program is, and how your local area Agency on Aging can assist you.
See more: Does Medicare cover home health care in PA?
Medicare not only offers coverage for various services, but also many different support programs to help alleviate the burden on family caregivers.
First, it’s essential to understand who qualifies as a caregiver under Medicare rules to ensure your loved one receives the necessary assistance.
Under the context of Medicare, a caregiver is an individual who provides substantial support and assistance to a person with a chronic illness, frailty, or disability. A caregiver can be a family member, friend or a professional hired to offer essential care and to support eligible Medicare beneficiaries.
To be recognized as a caregiver under Medicare, you must meet certain requirements. These qualifications may vary depending on the specific Medicare programs or services available, but generally the following criteria apply:
Medicare not only offers coverage for Medicare beneficiaries, but also offers several programs and services that provide support to the beneficiary’s caregiver. These programs are to help improve the quality of care for the patient and to alleviate the financial burden associated with caregiving. Some programs of note include:
Your local Area Agency on Aging the Caregiver Support Program. It offers support to caregivers that aims to reduce stress and financial burden for primary caregivers. To learn about your eligibility and the services offered, visit the program website.
Let’s look more broadly at the coverage of services for Medicare beneficiaries to help you understand what you may need to pay for out-of-pocket.
Services covered by Medicare include:
These are the services that Medicare does not pay for:
Under original Medicare, your cost for home health care services is $0. After you meet the Part B deductible, 20% of the Medicare-covered medical equipment is covered. If you need additional coverage through your insurance plan, you should look into Medicare Advantage Plans.
Some Medicare beneficiaries also qualify for Medicaid assistance. Medicaid Self-Directed Care programs allow for the participant or their representative to have decision-making authority over certain services, taking direct responsibility of managing their services with the assistance of a system of available support. In Pennsylvania, this program is known as Consumer-Directed Services, which includes: