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.
The Basics of 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.
In-Home Care Options Covered by Medicare Advantage
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:
- Assistance with everyday activities, such as cleaning, cooking, dressing and personal grooming
- Adult day care services
- Installation of grab bars, ramps or stair lifts
- Respite care
- Personal safety devices and medical alert systems
- Transportation for medical and non-medical purposes
- Massage therapy, acupuncture or other alternative therapies
- Meal delivery for homebound seniors
Other Options
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.
Costs, Eligibility & Enrollment
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:
- You are a senior aged 65 or older
- You are under 65 and are permanently disabled
- You are under 65 and have end-stage renal disease or Lou Gehrig’s disease
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.
