Which Type of Care is Not Covered by Medicare?
AMADA SENIOR CARE PITTSBURGH NORTHWEST
For more information about the author, click to view their website: www.AmadaPittsburghNW.com
Oct 31, 2024
Pennsylvania - Greater Pittsburgh Area
To say the world of Medicare is complicated might be the understatement of the century. Not only is general Medicare divided into four different parts – supplemental insurance plans sold by private companies have added additional layers of complexity to the program. When it comes to the kinds of care not covered by Medicare, the main focus of this blog will be to clarify that question with regard to home care specifically; as it’s important to know if, when and how Medicare covers home care expenses. This is especially relevant if you’re dealing with a home bound senior loved one after hospitalization, or a senior who has one or more conditions that require ongoing care.
To understand the types of care Medicare does not cover, it’s important to know two things:
1) Medicare is divided into four general parts; Parts A, B, C and D. Parts A, B and C contain some level of coverage for home care, but since part C involves additional costs to the consumer for coverage beyond the original government program – this blog will primarily discuss parts A and B.
2) There are two types of home care – home health or medical home care, and non-medical home care.
Does Medicare Pay for an In-Home Caregiver?
To read more about this topic, click here.
In a limited capacity, Medicare can cover an in-home caregiver, but coverage depends largely on a senior’s care needs as defined by the government. These care needs are generally outlined in the senior’s care plan – a document written by a physician or nurse that the senior will receive after they are discharged from a hospital or Skilled Nursing Facility (SNF). Often, a senior’s true care needs go beyond what Medicare is willing to provide coverage for.
When Medicare pays for a non-medical, in-home caregiver, it only does so if that caregiver is part-time and working alongside someone who is in the home providing another form of skilled care; like skilled nursing, physical therapy, speech therapy, or occupational therapy. Medicare does not pay for 24-hour home care, home meal delivery, or caregiver services like house cleaning (services not specifically related to a senior’s care plan).
It generally does not pay for Activities of Daily Living (ADLs), which are services critical for many seniors – unless, again, that kind of care is occurring alongside skilled care. ADLs include things like bathing, dressing, feeding, and toileting. For more detailed information on ADLs and what they entail, click here.
The Difference Between Medicare Part A and Part B
To read more about this topic, click here.
Medicare Part A primarily covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home health care. It focuses on services that require hospitalization or facility-based care.
Medicare Part B covers outpatient care, including doctor visits, preventive services, outpatient procedures, medical supplies, and some home health care. It focuses on medically necessary services and preventive measures that do not require inpatient admission.
Does Medicare Part B Cover Caregivers?
To read more about this topic, click here.
Even though many people think the “outpatient services” covered by Medicare part B include caregivers, the reality is that Medicare’s coverage of in-home care is extremely limited. In most cases, the highest number of hours a caregiver covered by Medicare can work is 8 hours per day or 28 hours per week. It’s important to remember that Medicare-covered home care only kicks in when there is some other form of skilled care being offered – therefore, a caregiver (like a CNA or HHA) covered by Medicare is almost always working alongside or in conjunction with another skilled care provider.
Does Medicare Pay for Home Health Care After Hospitalization?
To read more about this topic, click here.
It depends. If the post-hospitalization care plan involves other skilled services (like skilled nursing or certain types of therapy), Medicare may provide intermittent home care through Medicare Part A. However, if the care plan doesn’t involve skilled service aside from home care, the cost of a caregiver (or home assistant) is not covered.
Any post-hospitalization care within 14 days of a hospital discharge, if covered by Medicare, is covered under Part A. Any care provided 100 days after a hospital or SNF discharge will, if covered, be covered by Medicare Part B.
Regardless of whether a senior is covered through Part A or B, hours are virtually always limited to 28 hours per week at most.
Is In-Home Nursing Care Covered by Medicare?
To read more about this topic, click here.
Interestingly enough, Medicare Part A does cover some home health care (nursing care), in addition to hospice care, inpatient hospital stays, and care in a skilled nursing facility (SNF). However, it only covers this kind of care after a hospitalization or stay in a SNF, and the amount provided is very limited. More specifically, if you spend at least three consecutive days in either a hospital or Medicare-covered SNF, Medicare part A covers your first 100 days of home health care. That said, you still have to meet the eligibility requirements mentioned above (i.e. with regard to skilled care) and a few additional eligibility requirements. You also must receive home health care services within 14 days of your SNF or hospital discharge in order to be covered by Medicare Part A. Any care provided past the 100-day mark is covered by Medicare part B.
Which Type of Care is NOT Covered by Medicare?
A significant area where Medicare coverage falls short is in-home care and support for ADLs. Many seniors and individuals with chronic illnesses or disabilities require assistance with ADLs to live independently at home. This type of care is often provided by home health aides or personal care aides and includes:
Bathing and Grooming: Assistance with personal hygiene tasks, including bathing, shaving, and hair care.
Dressing: Help with putting on clothes and getting ready for the day.
Eating: Assistance with feeding oneself or preparing meals.
Using the Bathroom: Help with toileting, including transferring on and off the toilet, and maintaining continence.
Mobility: Assistance with moving around the home, including transferring from a bed to a chair or wheelchair.
Medication Management: Ensuring that medications are taken correctly and on time.
Since these services are considered non-medical, Medicare does not cover them under Parts A or B. Beneficiaries who need this type of care must look for alternative options, such as:
Long-term Care Insurance: Purchasing long-term care insurance can help cover the costs of in-home care and support for ADLs.
Veteran’s Benefits: If you are a veteran or the surviving spouse of a veteran, you may be eligible for certain benefits like the Aid and Attendance benefit or the Homemaker benefit.
Private Pay or Personal Savings: Wealthy seniors often pay for caregivers out-of-pocket, or through personal savings.
Community Programs: Exploring local and community-based programs that offer support services for seniors and disabled individuals.
Understanding what Medicare does not cover, particularly in the realm of non-medical in-home care and ADLs, is essential for people to make informed decisions about their healthcare and financial planning. By recognizing these gaps and exploring additional insurance options or savings strategies, seniors in need can better prepare for their healthcare future and ensure they receive the necessary support to maintain their quality of life.
- To view the original version of this article visit www.amadaseniorcare.com/2024/05/which-type-of-care-is-not-covered-by-medicare/
- Seniors Blue Book was not involved in the creation of this content.
Other Articles You May Like
Snack Smarter
Snack Smarter: How SnackEver Supports Your Specific Dietary NeedsIn today's health-conscious world, adhering to specific dietary requirements is more common than ever. Whether you're following a vegan, gluten-free, keto-friendly, or sugar-conscious diet, finding suitable snacks that align with your nutritional goals can be challenging. SnackEver is dedicated to simplifying this process by offering a diverse range of snacks tailored to various dietary preferences.Understanding the Rise of Specialized DietsThe increasing prevalence of specialized diets stems from various factors, including health conditions, ethical beliefs, and lifestyle choices. For instance:Vegan and Vegetarian Diets: Many individuals choose plant-based diets for health benefits, environmental concerns, or animal welfare considerations.Gluten-Free Diets: Essential for those with celiac disease or gluten sensitivity, this diet eliminates gluten-containing grains to prevent adverse health effects.Keto and Paleo Diets: These low-carbohydrate diets focus on high-fat and high-protein foods to promote weight loss and improve metabolic health.Sugar-Conscious Diets: Reducing sugar intake is crucial for managing diabetes, preventing weight gain, and maintaining overall health.The Challenge of Finding Suitable SnacksAdhering to a specific diet often means scrutinizing food labels and ingredients, which can be time-consuming and overwhelming. Many conventional snacks contain hidden ingredients that may not align with certain dietary restrictions, making it difficult for individuals to find convenient and compliant options.SnackEver: Your Partner in Healthy SnackingSnackEver addresses these challenges by curating a wide selection of snacks that cater to various dietary needs. Their commitment to promoting wellness is evident in their diverse product offerings and user-friendly website.Diverse Product CategoriesOur inventory is organized into clear categories, making it easy for customers to find snacks that fit their specific diets. Some of the categories include:Chips, Popcorn & Crunchy Snacks: For those craving something savory and crisp.Chewy Snacks: Ideal for a quick, satisfying bite.Cookies, Crackers & Baked Goods: Perfect for indulging in sweet treats without compromising dietary goals.Trail Mix, Granola & Nuts: Great for on-the-go energy boosts.Snack Bars: Including protein and energy bars for sustained nourishment.Diet-Specific SelectionsUnderstanding that each diet has unique requirements, SnackEver offers specialized sections for:Vegan: Snacks free from animal products.Vegetarian: Options that exclude meat but may include dairy or eggs.Gluten-Free: Products made without gluten-containing ingredients.Keto-Friendly: Low-carb, high-fat snacks suitable for ketogenic diets.Sugar-Conscious: Items with reduced or no added sugars.Paleo-Friendly: Snacks that align with Paleolithic dietary guidelines.Dairy-Free: Suitable for those avoiding dairy products.Organic: Products made with organically sourced ingredients.Kosher: Snacks that meet kosher dietary laws.SnackEver prioritizes quality by sourcing products from reputable brands and providing detailed ingredient information for each item. This transparency allows customers to make informed choices that align with their dietary needs and preferences. For those who enjoy variety and convenience, we offer subscription boxes tailored to individual dietary preferences. These boxes provide a curated selection of snacks delivered regularly, introducing customers to new products that align with their diets. Our mission extends beyond providing snacks; we are dedicated to promoting overall wellness and supporting our local Pittsburgh community. Learn more at www.Snackever.com.
How Cost-Plus Pharmacies Can Help Seniors Save Money on Medications
As we age, taking medications often becomes a part of everyday life. Whether it's for managing chronic conditions like high blood pressure, diabetes, or arthritis, these medications are necessary to keep us healthy. But for many seniors, the cost of prescriptions can be a major concern. With a fixed income, paying for medications can sometimes feel like a financial burden.One solution that has been helping seniors save money is something called Cost-Plus Pharmacy. Let us explain what Cost-Plus Pharmacies are, how they work, and how they can make a big difference in lowering medication costs for seniors.What is a Cost-Plus Pharmacy?A Cost-Plus Pharmacy is a type of pharmacy that operates a little differently from the typical drugstore you might be familiar with. In most pharmacies, the cost of medications is marked upsometimes by a lot. This markup helps the pharmacy make a profit, but it also means youre paying more for your prescriptions than the pharmacy actually paid for the drugs.On the other hand, a Cost-Plus Pharmacy sells medications at a price thats closer to what they paid for them, plus a small, reasonable markup. The idea is to be more transparent and fair about pricing. This can help lower the price you pay for your medications, which is great news for seniors, especially those who take multiple medications.How Does a Cost-Plus Pharmacy Work?To keep things simple, think of it this way: lets say a pharmacy buys a medication for $10. A traditional pharmacy might sell that same medication to you for $20, marking it up by $10 in order to make a profit. But in a Cost-Plus Pharmacy, instead of doubling the price, the pharmacy may only add a small amountmaybe $2 or $3.So, instead of paying $20 for that medication, youd only pay $12 or $13. That small difference can make a big impact when youre taking multiple medications each month.One of the best things about Cost-Plus Pharmacies is that theyre open about their pricing. They usually show customers exactly how much they paid for each medication and how much they are adding as a markup. This transparency helps you understand exactly what youre paying for, making it easier to see that you're getting a fair deal.Why Is This Important for Seniors?Many seniors take several medications to manage chronic health conditions. The cost of these medications can quickly add up, and its not always easy to find affordable options. For those on a fixed income, like many seniors, paying for medications can become a financial struggle.For example, according to the Centers for Medicare & Medicaid Services (CMS), the average senior spends about $1,200 per year on prescription drugs. That number can be even higher for those who take multiple medications regularly.Medicare Part D can help with some of these costs, but it doesnt cover everything. Plus, there are gaps in coverage, like the "donut hole," where seniors must pay full price for their medications after reaching a certain spending limit. This leaves many seniors paying high out-of-pocket costs for their prescriptions.Cost-Plus Pharmacies, such as Blueberry Pharmacy, aims to fix this problem. By offering lower prices on medications, these pharmacies can help seniors save money, making it easier to afford the medications they need without breaking the bank.How Can Cost-Plus Pharmacies Save Seniors Money?There are several ways that Cost-Plus Pharmacies help seniors save on their medications.1. Lower Prescription PricesThe biggest advantage of a Cost-Plus Pharmacy is that medications are sold at a lower price than what youd find at a traditional pharmacy. Rather than charging extra fees or high markups, these pharmacies focus on offering a fair price. For example, a medication that may cost $50 at a typical pharmacy could be priced at $35 or less at a Cost-Plus Pharmacy. Thats a savings of $15 on just one medication! If you need several medications, these savings can really add up over time.2. No Hidden FeesAt many regular pharmacies, you might find that your prescription comes with extra chargesdelivery fees, processing fees, or other hidden costs. These fees can make your final bill higher than you expected. Cost-Plus Pharmacies are often more transparent about their pricing. Theyll give you an exact breakdown of the cost, so you know what you're paying for. This way, you avoid any unpleasant surprises when its time to check out.3. Affordable Generic MedicationsGeneric medications are often much cheaper than brand-name drugs, but not all pharmacies carry affordable generics. Many Cost-Plus Pharmacies focus on offering a wide range of generic medications at lower prices. For seniors, choosing generic drugs is one of the easiest ways to save money without sacrificing quality. Cost-Plus Pharmacies make it easier to access these more affordable options.4. Special Programs for SeniorsSome Cost-Plus Pharmacies offer special programs to help seniors save even more money. For example, they may have senior discount programs or loyalty cards that give you even deeper discounts. Some pharmacies also offer free home delivery, which can be a huge help for seniors who may have trouble going to the pharmacy in person.5. Fewer Prescription ErrorsPrescription mistakes can be costlynot just in terms of money, but also in terms of health. If a pharmacy gives you the wrong medication or makes an error on your prescription, you may need to go back to correct it, which can add more time and money to the process. Because Cost-Plus Pharmacies tend to offer more personalized service and fewer customers, they often have fewer mistakes and are able to fill prescriptions more accurately. This can save you both time and money in the long run.As the cost of prescription medications continues to rise, finding ways to save money on those medications is more important than ever. For seniors, a Cost-Plus Pharmacy such as Blueberry Pharmacy can be a great option to lower prescription costs without sacrificing quality or service.By offering lower, more transparent pricing, Cost-Plus Pharmacies are helping seniors save money on the medications they need. Whether youre looking for a more affordable pharmacy in your area or you want to try an online option, these pharmacies can make a real difference in your healthcare expenses.If youre a senior or care for one, its worth looking into a Cost-Plus Pharmacy such as Blueberry Pharmacy. With a little research or by contacting us directly, you could be saving money on your prescriptions every month, making it easier to stay healthy without stressing about the cost. Reach out to us today!
The Gift of Organization: Simplifying the Holidays for Seniors and Their Families
The holiday season can be both a joyful and overwhelming time, especially for seniors. As loved ones come together to celebrate, the pressure to maintain a tidy and organized home can add stress to what should be a time of joy. At A Call to Order Professional Organizer, we believe that a clutter-free environment can foster peace and emotional well-being during the holidays. In this blog, well explore how organization can be a thoughtful gift, not just for seniors, but for their families too. Understanding the Emotional Toll of ClutterFor many seniors, the accumulation of belongings can lead to feelings of despair and overwhelm. As we age, it becomes harder to manage clutter, both physically and emotionally. It can be a source of anxiety, especially when the holidays come around, inviting family gatherings and festive celebrations. Tip: Look Beyond the StuffUnderstanding the emotional connection people have with their belongings is essential. Each item may carry memories or sentimental value, making the decluttering process challenging. Approach the conversation with love and empathy, reminding them that a simplified space can lead to greater peace of mind. Decluttering with PurposeOne of the best gifts you can give a senior this holiday season is a tidied and organized home. Not only will this create a welcoming environment for family visits, but it can also lighten the emotional load that clutter brings. Heres a step-by-step guide to facilitate the decluttering process:Step 1: Set the MoodCreating a pleasant atmosphere can make the decluttering process more enjoyable. Play soft music and have refreshments on hand to create a comfortable and relaxed setting. Encourage the person youre helping to share stories about their belongings, making the process feel less like a chore.Step 2: Start SmallTackling an entire home at once can be overwhelming. Begin with small areas, like a closet or a single room, to make progress feel achievable. Set a timer for 20-30 minutes, allowing for focused work without fatigue. Celebrate small wins together to cultivate a sense of achievement.Step 3: Sorting with LoveAs items are removed from their designated spaces, sort them into four categories: Keep, Donate, Sell, and Toss. Encourage seniors to keep items that spark joy while helping them understand that saying goodbye to certain belongings doesnt mean losing their memories. Keep: items they love and use regularly.Donate: usable items that could benefit others.Sell: items of value that may also be a source of income.Toss: broken or unusable items that no one will benefit from.Step 4: Create Functional SpacesOnce decluttering is complete, the next step is organizing the remaining items in a way that makes them easily accessible and functional. Use clear bins, labels, and designated spots for everything to maintain order. For example, frequently used items should be within reach, while seasonal items can reside in less accessible areas. Embracing the Spirit of GivingThe holidays are fundamentally about connection and support. By helping a senior declutter, you not only enhance their living environment but also reinforce familial bonds. Its about creating space for memories, laughter, and love during gatherings.Tip: Coordinate with Family MembersEncourage family members to pitch in and share the workload. This shared experience can facilitate deeper connections, ease the emotional strain, and promote teamwork. The act of organizing together reinforces unity, transforms the task into a celebration, and allows everyone to reminisce about the memories tied to certain items.The gift of organization can transform not only a home but the holiday experience itself. A peaceful, organized space fosters emotional well-being and allows seniors and their families to focus on what truly matters: togetherness and joy. Remember, the journey of decluttering is not just about discarding items; its about making room for love, laughter, and cherished memories. At A Call to Order Professional Organizer, we are here to support you in simplifying the holiday season for seniors and their families. Together, lets create a joyful and stress-free home for the holidays.
Local Services By This Author
Amada Senior Care Pittsburgh Northwest
Non-Medical 2611 Nicholson Road, Sewickley, Pennsylvania, 15143Chad and Vicki Craig, owners of Amada Senior Care Pittsburgh Northwest, both share a lifelong passion for serving our senior population. Having spent the last 25 years of their professional careers in advanced healthcare technologies for older adults, they understand the importance of providing the highest quality care at home so that our loved ones can age in place safely and happily.For both Chad and Vicki, providing quality care to support senior independence at home isnt just a passion, but a calling. Their appreciation for and dedication to our cherished elder community began at a young age. As a child, Chad would often choose to visit residents of a senior facility neighboring his home over playing kickball outside with friends his own age. When his father, a WWII veteran and amputee, was transitioned to a memory care facility for dementia, Chad didnt know about the options available that could have allowed his father to spend his last days enjoying the comforts of his own home. I felt guilty after my dad passed because I was not aware that I could have brought him home where he could have been in a familiar place surrounded by family, Chad recalls. Vicki experienced a very similar situation with her own grandmother, who declined quickly after she was moved from her own home to a care facility.Personalized Care for Seniors and Families in Pittsburgh NorthwestRecognizing that well-vetted, committed caregivers are a necessity to safely aging in place, Chad and Vicki felt compelled to start their own senior home care business. Chad, Vicki and the entire Amada Senior Care team have devoted themselves to delivering the highest quality of compassionate elder care. Their extraordinary level of service is the reason why Amada Senior Care Pittsburgh Northwest has a reputation for providing in-home caregivers who exceed client expectations, along with the highest rating (A+) from the Home Care Standards Bureau, the industrys standard-bearer.Chad, Vicki and the rest of the Amada Pittsburgh Northwest team couldnt offer the exceptional quality care that they do without investing time and effort into pairing trained and knowledgeable Amada caregivers with senior clients to promote their well-being and health. Their process of offering excellent caregiving assistance includes regularly checking with their senior clients and families to ensure that individual care needs and preferences are being met. Chad, Vicki, and the Amada Pittsburgh Northwest team are just as diligent in offering expert financial advisory services to help seniors and their families navigate the complexities of Long-Term Care insurance (LTCi) policies and VA benefits.We invite you to contact us at Amada Senior Care Pittsburgh Northwest to learn more about how we can be of service to help your senior loved one age with dignity and respect, while giving your family the peace of mind they deserve. We exist to enrich seniors lives by helping them retain independent living for as long as possible, and our services include providing funding solutions on how to pay for in-home care. It is our pleasure and honor to serve.Specialized Care by Amada Pittsburgh NorthWestWhen senior loved ones need assistance to manage health conditions, our trained caregivers at Amada Pittsburgh NW can address their unique needsFamilies can feel confident that Amada Pittsburgh NW caregivers have the training and education necessary to provide the specialized care meeting the individual needs of seniors who are contending with health challenges. Is your senior loved one recovering from a stroke? Does your spouse or another family member suffer from Alzheimers or dementia? Is your family trying to help an aging loved one manage symptoms of congestive heart failure (CHF), diabetes, Parkinsons or another chronic condition?Assisting Senior Patients Diagnosed with Alzheimers or Dementia According to the Alzheimers Association, nearly 6.5 million Americans were living with Alzheimers or another form of dementia as of 2022. A progressive disease that destroys memory and other key mental functions, Alzheimers and other forms of dementia impact not only the senior patient but the entire family, which is where Amada Pittsburgh NW comes in. Our team of dedicated and compassionate caregivers at Amada Senior Care Pittsburgh NW are highly skilled and trained in supporting activities of daily living (ADLs) and special pursuits and activities far and above the ordinary, thus bringing to our senior clients a sense of fulfillment and joy in their everyday lives. Supporting Senior Clients to Manage Symptoms of Parkinsons Disease There is still no cure for Parkinsons disease, a brain disorder characterized by shaking, stiffness, difficulty walking and talking, and balance and coordination issues. The symptoms of Parkinsons typically begin on a gradual basis worsen over time, so families can expect that a loved one diagnosed with the disease will need assistance with activities of daily living (ADLs) at some stage of this progressive disease. The professional caregivers at Amada Pittsburgh NW are trained and well-versed in how to assist seniors and other adults who are managing life with Parkinsons. Amada caregivers can help adapt the home environment, help monitor systems and communicate changes to the care team and family members, provide medication reminders, assist with prescribed exercises, and much more. Dedicated Respite Care for Families When a Senior Loved One is in Hospice When a senior loved one begins the journey of hospice care, an increased level of care and responsibility naturally come along with the familys deepening concerns. Whats required of the family can be unrelenting and exhausting in ensuring their beloved elders last weeks and days are filled with comfort and dignity. Amadas expert, compassionate caregivers can provide a much-needed respite from the continuous care and extreme mental and emotional output that accompany the final passage. With emotions running high, family members often neglect their most basic needs including showering, eating and sleeping. The option to step away for a brea can provide family members with the opportunity to rest, refresh and regroupknowing their parent, grandparent or spouse is in excellent handsreturning better able to be fully present with their loved one. Call 724-318-6668 to speak with one of our senior care advisors and find out more about how we can help either you or a senior loved one. Click on the links below to learn more about how Amada caregivers can help senior clients manage symptoms of various disease states. Alzheimers and Dementia Congestive Heart Failure COPD Diabetes Hypertension Parkinsons Stroke Recovery