Nursing homes provide 24-hour care for elderly patients who need constant monitoring and consistent medical attention, but not all seniors need this level of care. Seniors who don’t need constant medical attention often prefer to stay in their own homes, when possible. Mobility issues and difficulty handling daily living tasks, such as cooking, bathing and cleaning, often leave seniors with little recourse than to check into a nursing home, especially if they can’t afford the costs of an assisted living facility or in-home caretaker services.
Fortunately, Medicare Advantage provides some benefits that help with these issues, making it easier for seniors to continue living independently. This guide helps seniors understand their options for independent living under Medicare Advantage.
Medicare Advantage plans, also known as Medicare Part C, are a type of Medicare coverage that is provided by private insurance companies instead of directly through the government. Seniors aged 65 and older are eligible for Medicare Advantage, and some younger people with disabilities also qualify for the program.
Medicare Advantage covers a wide range of health and medical services, and the benefits differ depending on the specific insurance plan you choose. All Medicare Advantage plans offer the benefits provided by Medicare Parts A and B, the government plans covering medical care and hospitalization. Medicare Advantage plans also may offer additional benefits, such as vision, hearing, dental and prescription drug benefits.
In 2019, a major change in policy allowed Medicare Advantage plans to start including supplemental services as well. This includes in-home care, housekeeping services for qualifying seniors, adult day care, respite care, home modifications to enhance mobility and non-medical transportation. These changes make it easier for seniors to continue living independently, instead of moving into a nursing home.
The recent changes to Medicare Advantage to allow in-home supplemental services were specifically put in place by the Centers for Medicare and Medicaid Services (CMS) to encourage aging-in-place instead of forcing seniors into nursing homes when they didn’t really need to be there.
Because these changes are new, CMS has not completely defined what qualifies as supplemental services. Different Medicare Advantage plans may offer vastly different in-home supplemental options, so the benefits you get depend heavily upon which plan you choose. Some plans also include assisted living facilities and memory care facilities, which are designed for dementia patients, as in-home settings.
Some of the things that a Medicare Advantage plan might include as supplemental in-home services are:
Assisted living can serve as an alternative to nursing home care for seniors who are still active, but cannot or do not want to remain in their former homes. Medicare Advantage doesn’t cover room and board at an assisted living facility, but some plans may offer coverage for supplemental services provided to residents of an assisted living community. This can help make the cost of assisted living more manageable for families that choose this option.
In some cases, family members may help with everyday tasks and personal care services to help a senior remain at home instead of moving into assisted living or a nursing home setting. Supplemental services covered by Medicare Advantage may make this job easier for relatives.
Eligibility for Medicare Advantage plans is the same as for traditional Medicare. You can get Medicare if you meet any one of these three qualifications:
Because Medicare Advantage is run by private insurance providers, costs can vary widely. Most plans charge a monthly premium, and most have annual deductibles you must meet before the plan starts paying for care. Many plans also have co-pay fees you need to cover when you see a doctor or go to the hospital. Medicare Advantage plans typically have an out-of-pocket maximum as well, so once you have paid a certain amount for care, the plan covers all costs after that point.If you receive Social Security or Railroad Retirement Board benefits, you are automatically enrolled in Medicare at age 65. People who don’t get these benefits need to apply for Medicare. This automatic enrollment signs you up for traditional Medicare, so if you want Medicare Advantage, you need to apply directly for the Medicare Advantage plan you want or call 1-800-MEDICARE for help enrolling in the plan you choose.
Medicare Advantage plans are run by private insurance companies, but the government pays the companies a set amount of money per month to run these plans, so you don’t need to file your own Medicare claims.
Seniors on a Medicare Advantage plan also get the benefits of Medicare Parts A and B. This includes coverage for doctor’s appointments, hospitalization and urgent care visits.
Each Medicare Advantage plan is different, so you need to compare plans before you choose to make sure the one you pick covers what you need. Many plans now cover home health care, which includes skilled nursing care, physical therapy, speech therapy and other medical care provided in the home.
Most Medicare Advantage plans do not cover all of the costs that family members incur when caring for an elderly relative. Some plans may offer a bit of financial relief to families by providing coverage for respite care, transportation and other supportive services. This coverage can help family members better care for an older relative and make it easier for the senior to maintain an independent lifestyle.
Room and board at an assisted living facility are not covered by Medicare Advantage or traditional Medicare. However, seniors who live in an assisted living community can get supplemental services through a Medicare Advantage plan. This includes coverage for medical services and personal care services provided at the assisted living facility.