Non-skilled in-home care has been an allowable supplemental benefit for Medicare Advantage (MA) plans since 2019. When the Centers for Medicare and Medicaid (CMS) allowed this type of plan as a benefit under Medicare Advantage, it marked the first time that the agency has allowed any type of daily maintenance benefit as a supplemental benefit for MA plan holders.
The change came about as CMS sought to expand the definition of what it considers primarily health-related. The agency will now allow supplemental benefits, including non-skilled in-home care, if they “compensate for physical impairments, diminish the impact of injuries or health conditions and/or reduce avoidable emergency room utilization,” according to the CMS.
Covered non-skilled in-home services typically include assistance with daily living tasks and activities, with services provided in the plan holder’s home by a qualified provider. This includes tending to personal care needs such as bathing, dressing, eating and cleaning. Medication management and making sure that the covered individual takes needed medications and has transportation to medical appointments are also covered services. Non-skilled care is non-clinical help and is sometimes called home care, while skilled care is known as home health and requires a doctor’s order. Patients requiring home health may need physical therapy, monitoring of health status or care for a wound, for example, whereas those patients who need non-skilled care have less urgent needs.
Among those Medicare recipients who have a Medicare Advantage plan that offers non-skilled in-home care, there are a few obstacles to taking advantage of the benefit. A doctor’s order or a prescription is not necessary; however, the need for non-skilled in-home care must be recommended by a health care provider. It must also be deemed medically appropriate for the covered individual.
Seniors who need help with activities of daily living (ADLs) are the intended recipient of this type of Medicare Advantage benefit. This often includes elderly plan holders who may still be active but need help with transportation, cleaning, cooking or other types of responsibilities.
Medicare recipients should weigh their options when selecting Medicare Advantage plans well before open enrollment each year.