Have questions about Medicare? You’re not alone! Navigating the complexities of Medicare coverage, what’s covered and what’s not, is a common challenge for families and caregivers.
“Will Medicare Pay to Support Family Caregivers in 2024?” is a hybrid in-person and virtual webinar hosted by The Kensington White Plains to educate families on Medicare’s role in caregiving at home.
Join us on Jan. 31, 2024, to hear from expert Mark Brownstein, Director of Medicare for Emerald Medicare, as he demystifies Medicare plan options and recent CMS proposals for caregiver training.
Our event is part of our ongoing commitment to support caregivers in their roles.
Join us for this informative event and continue reading to learn how Medicare might assist you in your caregiving journey.
Our promise is to love and care for your family as we do our own.
A brief overview of Medicare coverage for caregivers and seniors
Medicare is a health insurance program for seniors 65 and older. While it’s known for its coverage of medical costs, its role in caregiving services is more nuanced.
Caregivers need to understand what Medicare can and cannot cover for certain situations.
In addition, Medicare Advantage plans or Medicaid can also cover more comprehensive coverage, including long-term care services (for senior living communities that accept these types of insurance).
Medicare provides coverage for medically necessary care such as:
- Hospital care, doctors’ services, lab tests
- Short-term skilled nursing and rehabilitation services
However, Medicare does not cover long-term custodial care, such as those found in memory care or assisted living communities.
Eligibility and requirements for receiving Medicare coverage
To receive assistance from Medicare, services must be deemed “medically necessary” and be prescribed by a physician.
For example receiving prescriptions for physical therapy, occupational therapy, or speech-language pathology.
Medicare coverage for skilled nursing facilities and rehabilitation centers is limited to up to 100 days after a qualifying hospital stay.
Home health care services may be covered if the patient is homebound and requires intermittent skilled care.
Ways Medicare may cover adult caregivers
If you’re a caregiver in or around Westchester County, New York, learning how Medicare may assist you in providing home health services or respite care coverage could be the helping hand you need.
Understanding these Medicare intricacies can help provide extra care to your loved one in need and benefit you, the caregiver.
Home health services
Medicare may cover home health services for beneficiaries requiring caregiving assistance, especially for those who are home-bound due to medical conditions.
Medicare may cover intermittent skilled nursing care, physical therapy, speech-language pathology, and occupational therapy.
These services are for beneficiaries who cannot easily leave their homes.
Respite care coverage
Medicare provides coverage for respite care under certain conditions to offer temporary relief for caregivers/
This typically includes short-term stays in a Medicare-approved organization such as a skilled nursing center or hospital.
This coverage is usually for a limited period, allowing caregivers a break from their duties.
Exploring Medicare plan options for caregivers
Medicare plans consist of several parts that cover different aspects of healthcare, such as paying for prescriptions, covering hospital visits and procedures, and visiting doctors.
Let’s look at the different Medicare parts plans:
Medicare Part A (hospital insurance)
This coverage includes hospital care, including skilled nursing facilities, hospice, and some in-home health care. Part A is essential for inpatient hospital services and post-hospital nursing and rehabilitation center care.
Medicare Part B (medical insurance)
Part B is optional and covers outpatient services, including physician and specialist office visits, preventative care, lab work, medical equipment, physical therapy, and mental health care.
Medicare Part C (Medicare Advantage)
Medicare Advantage plans, known as Part C, are an alternative to the Original Part A and B Medicare plans, and are offered by private insurance companies.
These Advantage plans offer similar benefits to Original Medicare A and B but can include additional benefits such as prescription drug coverage, and sometimes extra services such as dental and vision care.
Medicare Part D (prescription drug coverage)
Part D covers prescription drug costs and can be purchased as stand-alone plans or as part of Medicare Advantage plans that include drug coverage.
Supplemental coverage (Medigap)
Medigap plans, offered by organizations such as AARP, help cover the costs or “gaps” leftover that are not paid by Original Medicare, such as copayments, coinsurance, and deductibles
Plan G and other prescription plans
Plan G is one of the Medigap policies that offer comprehensive coverage for costs not covered by Medicare Part A and Part B. It’s one of the most popular supplemental pans because of its extensive coverage.
Alternative ways to get paid for family caregiving
Did you know in America that caregivers provide over $600 billion worth of unpaid care?
Beyond the financial costs of family caregiving, there are additional emotional costs as well.
Luckily In New York, some programs allow family caregivers to be paid for providing in-home care, although Medicare does not directly pay for these services.
The most widely used program is the Medicaid Consumer-Directed Personal Assistance Program (CDPAP).
This program is for people who require regular assistance with daily activities of living. With CDPAP, the patient receiving care must be 18 years and older and can choose their own caregiver, which can include family members such as adult children or friends. However, spouses are typically not eligible to be hired under this program.
For those not eligible for Medicaid in New York, the Non-Medicaid Expanded In-Home Services for Elderly Program (EISEP) offers similar benefits.
If you have questions regarding these programs, please ask our special guest Mark Brownstein at Emerald Medicare.
The Kensington White Plains is committed to educating caregivers and their families
The Kensington White Plains, with its assisted living and specialized memory care communities, Connections and Haven, is dedicated to supporting those with dementia and Alzheimer’s, and their caregivers.