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What Is NOT Covered by Healthcare

The most significant cost for aging adults is healthcare. Most people think that Medicare or Medicaid will cover their care requirements. A big awakening comes to seniors and their families when they realize that, while rehab or home health may be covered, typically the coverage is for much less care than the individual needs, for a much shorter period of time than families believe is required.

Following a significant medical problem requiring hospitalization, rehab is covered 100%… for the first 20 days. Then the Medicare daily co-pay begins to be incurred. Insurance companies determine the patient’s baseline, and if they determine the baseline has been met, the patient will be discharged.

This is when seniors and their families discover that non-medical custodial care is simply not covered by either Medicare or Medicaid. Custodial care includes such critical activities as:

Dressing, bathing, personal hygiene
Cooking, cleaning, laundry
Tracking medications
Attending doctors’ appointments
Transportation to store, doctors’ offices
Paying bills

Often families realize at the point of discharge that their loved one is simply not able to manage all of these activities on their own. They begin to look for care options, and discover that all non-medical custodial help for long-care needs automatically becomes private pay, with few exceptions. The cost of in-home care varies based on location, but a provider from a privately licensed, bonded and insured homecare agency typically runs $20/hour. This is a monthly cost of around $5,000 for 8 hours of care per day. A good option for some may be a day program, these typically cost $75-90 for an 8-hour day.

Assisted living is one of the options many families turn to, but are often surprised to find that the cost is $3500-6500 per month, not including individual custodial needs such as administering medication, helping with bathing and dressing, etc. Assisted living is not covered by Medicare or Medicaid… and Medicaid is only available to patients who qualify by having less than $3500 in savings, including any retirement funds.

This is the time when a local care manager can be a big help to families, providing a realistic evaluation of the number of hours needed per day, the times of day you or your loved one is most at risk, determining if he or she can be alone at all… and if they can’t, how do you supplement the care, create a family schedule, or, if it’s beyond what the family can manage, evaluate the cost and availability of alternative housing options.

If you are concerned about your loved one’s healthcare needs, Care Management of New Mexico is here to guide you through this difficult time. Contact us and we’ll be happy to talk with you.