Medicare and Home Health Care Costs

A 2010 study by the Minnesota Department of Health and Human Services says that by the year 2030, one in four Minnesotans will be over the age of 65. By the year 2050, that same number of people will be over the age of 85.  The U.S. Department of Health and Human Services growth studies mirror these estimates. The U.S. DHHS studies show that these individuals face a 40% likelihood of entering a nursing home, and of that number, 10% will reside there for 5 years or linger. Millions of Americans nationwide have a current need for eldercare, and the need will continue to grow over the next 30 years. Most will be cared for in the home and have family and friends providing that care. Minnesota has a policy in place that encourages planning for care at home. See Aging 2030 for more information.

Long-Term Care

“Generally, Medicare doesn’t pay for long-term care. Medicare pays only for medically necessary skilled nursing facility or home health care. However, you must meet certain conditions for Medicare to pay for these types of care. Most long-term care is to assist people with support services such as activities of daily living like dressing, bathing, and using the bathroom. Medicare doesn’t pay for this type of care called “assistive care”. Assistive care (non-skilled care) is care that helps you with activities of daily living. It may also include care that most people do for themselves, for example, diabetes monitoring. Some Medicare Advantage Plans (formerly Medicare + Choice) may offer limited skilled nursing facility and home care (skilled care) coverage if the care is medically necessary.”

To learn more, visit: Medicare.gov

Short-Term Care

Following an illness, injury, hospital stay, or surgery, a physician may order rehabilitation or short-term home health care services to help with rehabilitation and recovery, or to help manage medical conditions to prevent initial or re-hospitalization. Generally, short term home health care is provided by nurses, therapists and other professional clinicians, and home health aids. The physician will oversee a home health care and recovery plan and home care is provided until the goals of the plan are met. The period of time under a care plan is referred to as an “episode” and typically lasts between six weeks and 60 days. Short-term home health care is generally covered 100% by Medicare through the Medicare home health benefit or by a Medicare Advantage plan through private insurance.