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En español | Can I get financial help to pay for in-home care for my loved one?
Answer: In some instances, for some services, in some states.
- Medicare qualifications for home health care are specific. Check coverage to see if your family member’s needs are covered.
- Personal services. If your family member needs only assistance with personal services — such as bathing, feeding, dressing or homemaker services — or requires round-the-clock service, Medicare will not cover the cost of an aide.
- Short-term care. If your loved one is convalescing from an injury or illness and expected to return to previous health, meets eligibility criteria and has a doctor-created plan of care, and the services are reasonable and necessary for treatment of an injury or illness.
Long-Term Care Through Medicare and Medicaid
Program of All-inclusive Care for the Elderly (PACE) is for Medicare and Medicaid enrollees who need nursing home-level care and want to remain living at home. They can receive high-level in-home care. Participants are treated by a PACE team of doctors and providers in their state. PACE covers all care and services covered by Medicare and Medicaid with no deductible or copayment for any prescribed drug, service or care — including an in-home caregiver, skilled nursing and hospice ordered by the patient's PACE health care team.
To qualify, your family member must:
- Be enrolled in Medicaid or Medicare
- Be 55 or older
- Need nursing home-level care, as certified by your state
- Able to live safely in the community with help from PACE
- Live in a PACE service area in the United States or certain U.S. territories (not all states have PACE)
- Medicare participants pay monthly premiums for Medicare Part D and for the PACE long-term care portion of the benefit, but do not have deductibles or copayments.
- Medicare or Medicaid participants pay no monthly premium for long-term care.
- If you don't have Medicare or Medicaid, you can pay for PACE privately.
- What does PACE cover?
- Adult primary day care, including doctor and recreation therapy
- Emergency services
- Home care
- Hospital care
- Laboratory/X-ray services
- Medical specialty services
- Nursing home care
- Nutritional counseling
- Occupational therapy
- Physical therapy
- Prescription drugs
- Preventive care
- Social services — including caregiver training, support groups and respite care
- Social work counseling
- Transportation to the PACE center for activities or medical appointments, if medically necessary
Long-Term Care Through Medicaid
If your family member qualifies for Medicaid and needs long-term care, Home and Community-Based Services (HCBS) may be the solution. Issued by your state, the Medicaid waiver program was created to enable people who need significant services to stay out of institutional facilities and continue living at home. HCBS provides no-cost care tailored to the individual, including assisting with daily living — such as homemaker services and personal care — and providing transportation to medical and therapy appointments.
To qualify, your family member must:
- Be enrolled in Medicaid
- Fall within the resident’s state income and asset criteria
- Meet the level-of-care and functional eligibility standards
- Have a doctor-created plan of care
Benefits of this program depend on the state and may include:
- Home health aides
- Skilled nursing
- Personal care
- Case management
- Adult day services
- Adult day health care (offers nursing and therapy)
- Transportation to medical care
- Meal programs
- Senior centers
- Friendly visitor programs
- Help with shopping and transportation
- Help with legal questions, bill paying or other financial matters
- Employer or union coverage. If your family member is covered through an employer or union, ask their benefits administrator if skilled care and other health care services are covered.
- Medigap policy. Those who have Original Medicare may also have a Medicare Supplement Insurance (Medigap) Policy. Some Medigap policies pay the skilled nursing facility (SNF) coinsurance for days 21–100. Call the insurance company and ask if Medicare SNF coinsurance is part of your plan.
For more information on Medicare, call 800‐MEDICARE (800‐633‐4227); TTY users call 877‐486‐2048.
- Long-term care insurance. If your loved one has long‐term care insurance, call the insurance company to find out if skilled or custodial care is covered.
Figuring out how you can pay for a caregiver is important. Knowing how to hire a caregiver that is right for your loved one is essential.