Medicare Changes Will Help Many Seniors Stay Healthier & Wealthier

Bay Alarm Medical

October 17, 2018

In 2011, the New York Times published an opinion piece titled “How Medicare Fails the Elderly.” The author described his struggle to get his mother the care she needed versus the services covered by Medicare.

“Medicare, which pays for all of the above, does not, except in rare instances, pay for long-term care in a supervised, safe place for frail or demented old people, or for home aides to help with shopping, transportation, bathing and using the toilet.”

For years, federal law has required Medicare to provide home care for those with chronic illnesses as long as the care has been prescribed by a physician and “patients can leave home only with great difficulty.” However, most seniors who want to age in place aren’t that ill, so they don’t qualify under current rules.  They just need a little extra help with daily activities.

Fortunately, Medicare Advantage coverage changes in 2019 offer new opportunities and options.

Non-Skilled In-Home Care Is a New Benefit in Medicare Advantage

The new rule that takes effect next year recognizes that even relatively healthy senior adults sometimes need extra help with ordinary household and personal care tasks. Although many new technologies help seniors live more independently and safely, they can’t cook lunch, scrub the tub, or help someone choose an outfit and get dressed. Those tasks (at least for now!) require human assistance.

That’s why people are excited by the new CMS rule that allows Medicare Advantage to provide non-skilled home care services.

Seniors without a nearby support network usually don’t require skilled nursing care. They just need someone who can help with daily tasks and check in on a regular basis. There are many benefits:

  • Regular point of contact: The risk of dementia rises as people age. Regular visitors may notice problems quickly and help seniors get care.
  • Increased mobility: Regular social activities help seniors avoid depression. A home aide can help with transportation to social activities, medical appointments, and shopping.
  • Better nutrition: Senior malnutrition is more prevalent than people realize. It may seem depressing or too much trouble to cook for one. Transportation to buy food can be a problem as well. An aide can prepare several days worth of healthy meals that seniors can heat and enjoy.

Senior woman and doctor spending time in the garden

 

Additional Coverage May Extend to Assisted Living Services

Seniors currently living in or considering assisted living settings may also benefit. Although the CMS rule doesn’t explicitly say that non-skilled home care services received in an assisted living setting are covered, it doesn’t prohibit them either.  Many health care experts expect that senior living facilities will be eligible:

Although the call letter is not explicit on this point, it’s safe to assume that MA providers will consider a senior living setting to be a person’s home, according to Fred Bentley, vice president with Avalere Health, a health care research and consulting firm based in Washington, D.C.

CMS would want a broad definition of home in order to achieve the aims of this new benefit—namely, to keep people healthier for longer periods of time in lower-cost settings, reducing expensive emergency department visits and hospitalizations, Bentley told Senior Housing News.

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Helping Seniors Stay Healthier & Wealthier

Many families already pay out of pocket for non-skilled home care services.  In 2019, seniors who choose a Medicare Advantage plan that provides this coverage can save money.  It’s a double benefit: seniors stay healthier and wealthier – both allow them to live more independently and with less worry.

Keep in mind, however, that this supplemental care is not full-time home care.  Many seniors still need a reliable way to summon help in case of emergency.  A home medical alert with fall detection will summon help even if the person is unconscious or unable to speak. When Bay Alarm Medical’s trained operators dispatch first responders, they provide the health history and information paramedics need to provide quality care without question or delay. The medical alert system is always on and always ready to respond.

Medicare Open Enrollment begins October 15 and closes December 7 each year. Call 1-800-MEDICARE or go to Medicare.gov to get more information and/or compare plans.  Remember that non-skilled in home care is an optional benefit that Medicare Advantage plans aren’t required to provide.  Carefully research plan specifics before you make a choice.

 


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