Q: I thought Medicare would pay for care at home after my surgery. What does Medicare pay for at home?
A: I often hear from people a misconception about what Medicare covers for care in the home. It is very important for people to understand the benefits and limits of this insurance. It can help you plan for care and understand your options.
Medicare does not typically cover most in-home care services unless they are deemed medically necessary and ordered by a doctor. Examples of covered services may include skilled nursing care, physical therapy, and occupational therapy. Medicare may also cover some medical equipment and supplies needed for in-home care.
Following your surgery, they may send you home with a prescription for home health care. This means a home health care agency will send someone to your home to assess what services are needed and medically required. They may set up a schedule that includes a visiting nurse, physical therapist, and occupational therapist. It may even include someone to help with bathing temporarily. These are time limited services specific to a medical need.
It is important to understand that Medicare does not cover non-medical home care services such as assistance with activities of daily living (ADLs). This means that Medicare will not cover a caregiver to provide companionship, make meals for you, provide transportation, and personal care, such as assistance in the bathroom. You will have to pay out of pocket for these types of services if you require them. Typically, home care agencies cost around $35 per hour for a caregiver and often have a minimum number of hours required per shift (most often 4 hours).
If you are unable to afford the cost, you can reach out to family and friends to assist or seek assistance from Medi-Cal or other state programs, if possible. Also, sometimes after surgery if you are eligible, the hospital will offer rehabilitation in a facility short term. This is a good option if you need the care and cannot afford to pay for it at home.
The Medi-Cal program in California can offer eligible recipients home care through a program called In Home Support Services. This means it will pay for a certain number of approved hours of home care per month. Medicare, on the other hand, does not offer this type of home care benefit.
Medicare policies and coverage can vary based on individual circumstances and specific plans, so it is always best to check with your healthcare provider or the Medicare website for more information .
If you have a Medicare Advantage or supplemental plan it may offer additional services, such as temporary home care or home delivered meals.
If you find that you do not know where to turn for more help at home, reach out and talk to a professional who can help guide you based on your specific needs. Contact the Ventura County Area Agency on Aging at 805-477-7300. They can help provide you information or referrals or direct you to a local Caregiver Resource Center.
Plan ahead and be realistic about your needs and resources. Make sure to ask specific questions to your doctor as well to better understand what help you will need post-surgery. It is always better to have more in place just in case than to end up at home without the care you need.
Martha Shapiro can be reached at Senior Concerns at 805-497-0189 or by email at mshapiro@seniorconcerns.org.
