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Ohio Department of Aging Aging Connection - March 2010

Aging Connection

CONNECT TO | Policy & Legislation
March 2010

Caregivers Need to Understand How Medicare Works
Know the Qualifications and Services Available

At least 44 million Americans care for chronically ill, disabled, elderly family members. Home health care enables caregivers to keep their loved ones in their homes. Medicare can cover a lot of the costs associated with providing health care services in the home, but it is a large, complex program and it can be confusing as to what it does and does not cover.

Medicare coverage for home care

Generally, Medicare covers home health care if:

  1. The individual's doctor decides medical care at home is necessary and makes a plan for care at home;
  2. The individual needs intermittent skilled nursing care, physical therapy, speech-language therapy or to continue occupational therapy;
  3. The home health agency caring for the individual is approved by the Medicare program (Medicare-certified); and
  4. The individual is homebound or normally unable to leave home without help.

If an individual meets all these conditions, Medicare will cover:

  • Skilled nursing care on a part-time or intermittent basis, including services and care that can only be performed by either a registered or a licensed practical nurse;
  • Home health aide services on a part-time or intermittent basis, which includes help with bathing, using the bathroom, dressing or other personal care (Medicare does not cover home health aide services unless the individual also requires skilled care);
  • Physical therapy, speech-language therapy and occupational therapy for as long as the individual's doctor says he needs it;
  • Medical social services to help with social and emotional concerns, including counseling or help in finding resources in the community;
  • Certain medical supplies, like wound dressings (but not prescription drugs); and
  • Durable medical equipment, such as a wheelchair or walker.

Medicare also pays for many preventive services, including a one-time "Welcome to Medicare" physical exam, cardiovascular screenings, cancer tests, flu shots and diabetes screening, supplies and self management training, as well as other tests.

Currently, Medicare does not cover 24-hour care at home, meals delivered to the home, homemaker services like shopping, cleaning and laundry, or personal care given by home health aides when this is the only care an individual needs.

If you are helping a loved one who is covered, visit "Ask Medicare," at www.medicare.gov/caregivers, for easy access to information and links that will help you compare and choose a drug plan, compare nursing homes, get help with billing and financial resources and more.

You also can call the Ohio Senior Health Insurance Information Program at 1-800-686-1578 to talk with a trained representative about Medicare and other senior insurance topics such as long-term care insurance.

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Policy & Legislation

Spending, Demand Up for Medicaid Home and Community-Based Service Programs
Developing home- and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. The national percentage of Medicaid spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007. A Kaiser Family Foundation report shows that spending on Medicaid HCBS programs rose eight percent in 2006, serving 2.9 million people. Demand for these services continues to increase, with 393,096 individuals on waiting lists for HCBS waiver programs nationwide, as of 2008.

Most Not Accessing Tax Incentives for Long-Term Care Insurance
The AARP report, Federal and State Income Tax Incentives for Private Long-Term Care Insurance, describes tax subsidies for long-term care insurance. According to the report, most policyholders did not receive federal tax subsidies, and while many qualified for state tax incentives, these incentives are usually too small because of low tax rates.