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Exploring Medicare Options: What’s Covered and What Isn’t? | Generations Home Care
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    Medicare Options

    Ensuring your insurance covers your necessary medical treatment can be complicated—especially for people on Medicare. While this program can provide essential protection for people who might otherwise struggle to find the right insurance, knowing what Medicare covers and what it doesn’t is the key to making the most out of this service. 

    Unfortunately, Medicare coverage can be confusing to people who are just trying to find care. Those who require long-term in-home care may especially struggle to navigate their options in regard to covering these essential services. 

    At Generations Home Care, we’re proud to work with our clients and help them find the best options for connecting with care. Here’s everything you need to know about what Medicare covers and what it doesn’t, and what you can do if you need in-home care options that Medicare won’t cover. 

    How Does Medicare Work?

    Medicare is federal health insurance for people 65 or older, people with disabilities, or people with permanent kidney failure. It is more affordable than many other private health insurance options and can provide a broad umbrella of coverage to people who need it. 

    Parts A, B, and D

    One thing that can confuse people about how Medicare works is how it’s broken down into different parts. Each part offers different insurance coverage and is included under different plans. 

    The parts offer the following coverage:

    Part A: Hospital coverage. This includes in-patient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people don’t pay a premium for Part A Medicare if they worked for a job that paid Medicare taxes for some time. This is often called “premium-free Part A.”

    Part B: Medical coverage. This part covers some doctors’ services, outpatient care, medical supplies, and preventive services.

    Part D: Drug coverage. This additional optional coverage can lower the cost of prescription drugs. 

    You may have noticed that while the different parts of Medicare appear alphabetically, no Part C is listed above. Part C is commonly known as the Medicare Advantage plan, which usually combines Parts A, B, and D into a single package. 

    Original Medicare vs. Medicare Advantage

    So what are the significant differences between Original Medicare and Medicare Advantage? Here are a few key points:

    Flexibility

    Under original Medicare, you can generally see any doctor that accepts Medicare in the US, and you don’t usually need a referral to see a specialist. With Medicare Advantage, you must use doctors within your plan’s network, and you may need referrals to see a specialist. 

    Costs

    While original Medicare offers more flexibility in care, it can also be more expensive. You usually pay 20% of your Medicare-approved amount after meeting your deductible with original Medicare, pay a premium for Part B, and are not limited in the amount of out-of-pocket costs without supplemental coverage. 

    The cost of Medicare Advantage may vary, but plans have a yearly limit for the amount of out-of-pocket expenses you pay for covered services. 

    Coverage

    Original Medicare covers all necessary services. Medicare Advantage covers those services as well as the potential for vision, hearing, and dental services. People using Original Medicare must also join the Part D plan to get additional prescription drug coverage; Medicare Advantage includes that coverage.

    How Can Medicare Help With In-Home Care?

    In some cases, Medicare can extend to cover in-home care services. The main question is whether the person requiring care is considered to be “homebound.” People who are homebound due to chronic illness or injury may qualify for the following under Medicare: 

    • Part-time or intermittent home health services.
    • Medical social workers to help with emotional care.
    • Occupational therapists to help people with daily tasks.
    • Physical therapists to help restore movement lost due to injury or extended hospitalization.
    • Speech language pathologists to help restore speech and swallowing after a stroke.
    • Skilled nursing care.

    However, there are also restrictions to getting in-home care under Medicare. Namely, Medicare will not cover 24-hour in-home care, and you must be under a doctor’s care who includes in-home care as part of your treatment plan.

    Lastly, you must be sure to work with a Medicare-certified agency for your home health care — such as Generations Home Care.

    About Generations Home Care

    Generations Home Care personalized in-home care and support services help those recovering from illness, injury, or surgery, living with a chronic disease, or dealing with the natural process of aging. We help people live a fuller, healthier, and independent life.

    Our caregivers are trained in the Centers for Disease Control (CDC) recommended COVID-19 safety precautions. We offer levels of care ranging from companionship, to respite for the primary family caregiver, to homemaking services, to assistance with activities of daily living, to Alzheimer’s and dementia care. Generations Home Care takes a holistic approach and emphasizes a consistent, client-centered plan of care.

    Our Specialty Services Include:

    • Rehab or hospital-to-home programs for safe discharge.
    • Short-term post-operative care during recovery periods.
    • Non-medical life management services for people with chronic conditions.
    • Veteran’s connection to care program.
    • Live-in services and couples care.

    If you’d like to learn more about how we can help you, contact us today at 602-595-HOME (4663) or by filling out the contact form on our website.


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