At Home Services Are Different Between Medicare and Medicaid

Health Care Dialogue Continues

One of the great confusions when seeking access to government health benefits is the similarity between the words “Medicare” and “Medicaid.” Even seasoned professionals in the field sometimes slip and use one word instead of the other. There are major differences between the two programs and one area where this becomes very clear is in the provision of home care services.

Medicare is essentially for rehabilitation, very often after hospitalization, and is generally limited in time – up to 100 days and often much less. Medicare “rehab” also alternatively could provide these services in a skilled nursing facility, a rehab facility or what is referred to as a “step down” unit. Medicare rehab in these environments also is time limited up to 100 days. Medicare services are not dependent on your income and, therefore, it is not necessary to go through the details of your income and assets to qualify for Medicare benefits.

Medicaid Florida, on the other hand, under the Medicaid Aging Waiver Program which is for individuals age 60 and older may offer help for non-medical at home health care for a longer period of time but it is severely limited in Pennsylvania to applicants with gross incomes including but not limited to gross Social Security not to exceed $2,742 per month based on the 2023 figures.

Differences between the Medicare program and the Medicaid program usually means that many Pennsylvanians eligible for Medicare may have rehabilitation help either at home or in skilled nursing for a limited period after hospitalization but longer term government supported non-medical home health care assistance is largely out of reach for vast numbers of Pennsylvanians. There are some limited alternatives but, generally speaking, you pay privately instead. Under the Medicaid Aging Waiver program in Pennsylvania it does not matter how much care costs for you. What matters for approval is your gross monthly income from all sources.

If you need additional help after hospitalization, Medicare may be the answer for a limited period. This ignores, by the way, the issue whether you might have other private insurance or through a current or former insurer where there might be additional at-home assistance.

Here are some descriptions of the types of help under Medicare (not Medicaid) available for rehab and what they can or will not offer.

Medicare Assistance After Leaving the Hospital. OT, PT and Home Health Care. The terms in the field are OT (Occupational Therapy), PT (Physical Therapy), and Home Health Care. Although “occupational therapy” seems to imply it is intended to provide recovery so you can return to work, that is not necessarily the case. Actually, recipients of OT may be and often are retired or homemakers or disabled and not intending to relearn employment skills.

Occupational therapy has to do with being able to perform basic tasks such as dressing and showering. It is task related. Physical therapy, on the other hand, concerns regaining strength and capacity. You could be lifting weights or stretching. Some services may overlap. Think about what is it you would like to do but are unable to perform because of your temporary disability and then discuss this with your occupational therapist.

Visits by Nurses. If your physicians’ or hospital’s orders include home visits by neighborhood nurses, you might expect periodic visits to have your vital signs taken such as blood pressure, heart and so on. Where appropriate, you may receive instructions on diet and medication. Your nurse might check on wound care or give injections. Nurses who visit the home do not provide non-medical services but can be covered under Medicare.

Hospice. Hospice is a coverage under Medicare Part A. To be eligible for hospice your doctor needs to certify that you suffer from a life-limiting condition with a prognosis for six months or less if the disease runs its normal course. If you have a life ending condition, hospice does not have financial limitations such as required by Medicaid at home care.

Non-medical home care. Non-medical at home care other than the above is not covered by Medicare. It can involve feeding, dressing, bathing, assisting with toileting, but also running errands, taking you to the doctors or providing companionship. What you are often looking for is a plan of care to get you back to where you were or nearly so. The various professionals involved can assist you to achieve that goal.

About the Author Janet Colliton

Esquire, Colliton Law Associates, P.C. Janet Colliton has practiced law for over 38 years, 37 of them in Chester County, Pennsylvania, a suburb of Philadelphia. Her practice, Colliton Law Associates, PC, is limited to elder law, Medicaid, including advice, applications and appeals, and other benefits planning including Veterans benefits, life care and special needs planning, guardianships, retirement, and estate planning and administration.

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