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Thread: From Medicaid to Medicare: Difference in Home Care / Aid?

  1. #1
    Senior Member
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    From Medicaid to Medicare: Difference in Home Care / Aid?

    Right now my husband qualifies for 65 hours per week of home care/ nurses aid . He pays absolutely nothing for this. When he changes to medicare (2 yrs after injury), how will this change? Will he have to pay 20% of cost for aid?

  2. #2
    Senior Member anban's Avatar
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    Medicare doesn't cover this service...he should still be Medicaid eligible due to his physical needs. You need to check w/ his worker to make sure, but it shouldn't change. If he continues to get Medicaid, that will pick up the 20% Medicare doesn't cover under Part B.

  3. #3
    States vary in what they cover under Medicaid. Medicare though is pretty consistent throughout the country, since it is a federal program. Most people who qualify for Medicaid by income continue to qualify for it as their secondary insurance once their Medicare starts. Don't forget that you must have Medicare B (not A) for home care. You have to sign up for both A & B, and D as well unless you can show you have another insurance that pays for all your meds.

    Medicare generally does not pay for what they consider "maintenance" or "custodial" home care, which is care that is provided to support daily living needs (dressing, bathing, ROM, transfers, homemaking assistance, etc.) that can be done by an aide and does not require skilled care (ie, can only be done by an RN or LPN/LVN). Even for skilled care, there is limited coverage. For example, Medicare may pay for a home care RN to come to your home to do AND teach a family caregiver to do catheterizations, but rarely will pay for more than 4-6 sessions for this, and then the family caregiver is expected to take over. This may also apply to "skilled" procedures like bowel care or wound care.

    In addition, the home bound rule generally applies, so if you leave your home for any reason, even medical appointments, church or school, it may mean you cannot get Medicare funded home care.

    Also, for home care PT and OT, and some nursing skilled home care, the agency must be able to show that the care is improving your level of independence or health, and if not, and it is for "maintaining" your health, or functional status, it may be denied.

    Suggest you sit down with a counselor from your local ILC and discuss how this goes in your state, well before you get to the date of your Medicare eligibility start.

    (KLD)

  4. #4
    I agree 100% with the previous posts, Medicaid eligibility should not be affected by Medicare eligibility. He will become what is commonly referred to as "dual-eligible", with Medicare as a primary and Medicaid as a secondary insurer. Some folks even end up tri-eligible, with a private (usually employer sponsored) insurer as primary, Medicare secondary, and Medicaid third. For Medicaid to caver services Medicare will have to deny them, so timing approvals is important to avoid gaps in coverage. As SCI-Nurse suggested, meeting with a local Independent Living Center would be beneficial for understanding how everything will work in your state.

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