3 Medicare Benefits You MUST Know About

“What do you mean Medicare doesn’t cover this?” My friend Sarah was caught off guard when I told her that her parent’s health insurance program doesn’t cover her parents’ care.

What I explained is that there’s a lot Medicare doesn’t cover and one of the biggest gaps is the ongoing, long-term care that people need when they become frail or disabled.

This care is expensive! Hiring someone to help with cooking, laundry, transportation or personal hygiene can cost around $20 per hour!

So what do families do? Well, one of two things. They pay for this care out of their savings… or much of the time, DAUGHTERS PROVIDE THE CARE THEMSELVES.

In fact, new research shows that most of the really frail older adults in this country don’t live in a nursing home. Most live at home and the vast majority — 2/3rds to 3/4s — are being cared for ONLY by family members — unpaid.

Daughters, in particular, end up providing care when the money to pay for help runs out. They do it because their parents refuse outside help or don’t want to move to assisted living. Or, because even the paid help is not enough … there’s always more care to provide. It’s just bottomless … this need.

Whatever the reason, women sacrifice a lot to give their parents the daily care they need. It’s an amazingly beautiful thing this daughterhood. But it’s also incredibly hard.

But, while there’s a lot it doesn’t cover, Medicare does offer some benefits that can help — if you know how they work. These services can provide important support for very frail, older adults.

These are the secret weapons of the Medicare program.

Secret Weapon Number 1: Medicare-Covered Home Health Care.

Medicare created the home health benefit with the idea that it would be cheaper and better if people could get some skilled services at home and not just at hospitals and skilled nursing facilities.

Here are some cool things about Medicare home health:

No copay. There is NO copayment for Medicare home health.
No hospital stay required. Your parent doesn’t have to have been in the hospital first to qualify for home health.

But, the downside is that qualifying for home health is not easy. Medicare has some strict rules to keep the program costs under control.

First of all, your parent has to be in such a frail condition that leaving the house (called “homebound” in Medicare), to get care is near impossible AND secondly you need a doctor willing to declare that the care they need requires professional skills — like nursing, physical, occupational or speech therapy.

The good news is that if your parent meets these criteria, a Medicare-approved home health agency can provide services and supports for up to 60 days at a time (before you have to be re-qualified).

If you think this might be something you’d like to explore, the first place to start is with your parent’s doctor. If your parent’s physician seems clueless — which is always a possibility — call one of the agencies that provides home health in your area and see what their process is for evaluating your parent. Use this tool for finding an agency and make sure to pick one that has high Medicare quality ratings. You can use this checklist to evaluate the service you’re getting.

Secret Weapon Number 2: Medicare Hospice Benefit.

Hospice is the shining light of the Medicare program.

It’s set up to do what the whole rest of Medicare should do, serve the needs of frail elders in a holistic and sensible way..rather than rely on family members to perform heroics just to avoid disastrous care.

Unfortunately, qualifying for Hospice requires that your parent be physician-certified as having only six months left to live. You also have to be willing to give up continuing treatment for the illness. In other words, you’re trading curative treatment for what’s called “palliative treatment,” which is designed to address needs for comfort rather than provide heroic interventions.

But, what you get is a system of support for the family caregiver and the dying person that ensures a multitude of needs are met. It provides physician and nursing care but can ALSO include a social worker, care aides, and grief counseling. And, best of all, these are often provided at home, although they can also be provided in a nursing home at end of life!

I highly recommend that any daughter taking care of her parent — no matter what stage of illness or need, even if your parent isn’t anywhere close to end of life — read this resource and get informed about this amazing part of the Medicare program.

Secret Weapon Number 3: Medicare Skilled Nursing Facility Care.

in a previous blog, I mentioned that many frail older adults leaving a hospital go first to a skilled nursing facility for rehabilitative care.

Some of these facilities are just ok but some are excellent providing much better care than a hospital for routine medical issues. Outstanding facilities will know how to prevent delirium and help you get past it if it occurred during a hospital stay.

Unlike home health, Medicare only pays for skilled nursing facility care after an inpatient hospital stay of at least three nights. Also unlike home health, there’s a copayment after the first 20 days which could be covered under supplemental insurance so be sure to check on that.

Follow my advice here for choosing a facility. While the Medicare ratings are highly imperfect they can help you avoid bad places.

Let’s be clear, none of these options will come close to meeting what is almost certain to be an overwhelming need and expense in your life. But, know that you’re facing a situation that most women have to face at some point in their lives. Learning how Medicare works can take some of the worry from your life and ensure your parents get all the benefits to which they’re entitled.

This is quickly becoming a universal experience. You are not alone!!

Visit the daughterhood website and let us know what your biggest challenges are in paying for your parents’ care. By sharing our stories we can be seen and we’ll all feel less alone.