UNITED STATES—Dear Toni: I need your help regarding my husband’s parents who are in their late 80s. My mother-in-law has been sick for the past 3 years and my father-in-law has been her caretaker.

He now has health issues and was just released from the hospital. Now he cannot be her caregiver.

They do not have a Long-Term Care plan and discussing having live-in help or living in an Assisted Living facility is out of the question. Their big worry is that they will outlive their retirement money and be unable to provide for themselves.

Our major concern is that we know they cannot properly take care of themselves, and the family is concerned that something serious can happen with them living on their own.

What rights does one on Medicare have with choosing their care at home and what will Medicare pay for? Sandy in Phoenix, AZ.

Hi Sandy: Do not feel like you are alone because many baby-boomers are experiencing just what you are facing. Elderly parents can be quite trying because they do not want to lose their independence, but cannot care of themselves. Many in this age bracket do not have a Long-Term Care Policy and are very conservative when it comes to spending extra money.

I have experienced the same type of issue with my own mother and other elderly relatives. We talked with a home health agency who explained how to maximize our elderly family members Medicare dollars with home healthcare benefits. There is not a co-pay or deductible for home healthcare. “Original” Medicare will pay 100 percent for any medical services provided by a home healthcare agency.

Those on “Original” Medicare not Medicare Advantage plans have “Patient’s Rights” with the “right” to choose which home healthcare agency to use. Those who are enrolled in a Medicare Advantage plan must use network providers and may be limited to how much home healthcare one can receive. Be sure which way your elderly family members are receiving their Medicare benefits.

To receive home health care services from Original Medicare:

  • There must be a medical need to receive home health
  • The Doctor must order the home healthcare
  • You must need intermittent skilled nursing care, physical, speech or occupational

Medicare must certify the home health agency.

  • You must be Homebound meaning that leaving home takes considerable and taxing effort. Someone can be homebound and still go to the beauty shop or go to church.

Once these conditions above are met, Original Medicare will cover the types of care listed below:

  • Skilled nursing care which can only be performed by a licensed caregiver.
  • Home health aide that can assist in bathing, dressing and other personal care that must be part of the health care for the illness or injury.
  • Physical, speech or occupational therapy
  • Durable medical equipment such as wheelchair, walker, or crutches

Remember that Home Healthcare is limited to how much time is spent at home and does not help with taking care of the elderly once the medical need is taken care of.

Home Healthcare is a Medicare option to help when one needs medical help at home, limited in care and paid by Medicare. “At home care” is not a Medicare option and is paid for with personal dollars not Medicare dollars and can help to build a Long-Term Care needs plan which can be a few hours a day, 8-10 hours a day or 24-hour care per day. Email info@tonisays.com or call 832-519-8664 with your Medicare questions.

Toni King, author of the 2022 Medicare Survival Guide® Advanced edition is giving a $5 discount on the Medicare Survival Guide® Advanced book at www.tonisays.com.