Hiring a caregiver can be expensive, especially if you don’t have health insurance. What’s even more frustrating is that the government-funded Medicare program, which should provide medical coverage for the elderly and disabled members of our community, doesn’t cover CDPAP.
This begs the question: why doesn’t Medicare cover CDPAP, and what other options are there?
What is CDPAP?
The Consumer Directed Personal Assistance Program (CDPAP) is a Medicaid program that allows consumers to choose and hire their own caregivers. These include close friends and family members.
Since this is a full-time role, Medicaid considers it only fair to reimburse them for their time and efforts. Anyone is eligible for CDPAP as long as they:
- Require homecare
- Have Medicaid
- Are self-directing or have someone who can effectively direct their care
What’s more impressive is that CDPAP beneficiaries don’t incur any added costs for the homecare service. All they need to do is request a CDPAP personal assistant. Then prove that they need homecare through various documents provided by their doctor. They also need a certification from a nurse’s visit to ascertain their case.
Additionally, the caregiver doesn’t need prior caregiving experience or certification. The beneficiary or their doctor provides all training to help them offer the best possible care for the beneficiary. However, all caregivers must undergo a full medical checkup with a TB test and provide proof of Rubella and measles immunity.
Medicare vs. Medicaid
Medicare is a medical insurance policy designed for US citizens aged 65 and older who have difficulty covering their medical expenses. People under the age of 65 living with disabilities may also be eligible for Medicare benefits.
There are two main branches of Medicare: original Medicare and Medicare advantage.
Original Medicare is a government-funded policy used by most older Americans. It covers:
- Inpatient medical services (Part A): These benefits cover hospice care, hospital visits, at-home healthcare, and limited skilled nursing facility care.
- Outpatient medical services (Part B): These benefits cover preventive, diagnostic, and treatment services for various medical conditions.
Medicare Advantage, also known as Part C, works much like original Medicare but with added benefits. It also costs more. You can only get Medicare Advantage plans from private insurance companies. Most Medicare Advantage policies cover services like dental services, prescription drugs, and hearing and vision care-none of which are covered in the Original Medicare plan.
Medicaid is a medical assistance program that combines the efforts of the US state and federal governments to assist individuals from low-income households with healthcare expenses. These benefits range from covering major hospitalizations and treatments to routine medical care.
Most Americans qualify for both Medicare and Medicaid. Having dual legibility works great since Medicaid may cover the medical expenses that Medicare doesn’t.
Why Doesn’t Medicare Cover CDPAP?
Since it’s run by the federal government, Medicare must comply with federal regulations pertaining to eligibility and coverage. And, despite having added coverage benefits for people enrolled in Medicare Advantage, none of the added benefits offers long-term features for home-based health services.
Here are a few other reasons why Medicare doesn’t cover CDPAP.
Medicare Doesn’t Have the Option of Long-Term Care Benefits
Medicare doesn’t offer long-term care benefits. It only covers what’s medically necessary, such as drugs, hospital stays, and doctor visits. However, it may make exceptions for services such as physical therapy and medical equipment deliveries. In this case, Medicare will pay. But it NEVER covers custodial care.
Medicare Only Covers Medical-Related Benefits
All Medicare categories, including Parts A, B, and C, only cover immediate care. Therefore, all medical care that the plan covers is either therapeutic or medical. Particularly when used together with a treatment plan. That said, any homecare approved by the plan is only on a part-time basis and is only done by home nurses.
Medicare Covers an SNF but Doesn’t’ Cover a Long-Term Nursing Home
A Skilled Nursing Facility (SNF) isn’t anything like your typical nursing home. Patients are only transferred to SNFs for further recovery. In such cases, Medicare offers coverage for the first 100 days. After which coverage ceases.
How Can You Get Home Health Services With Medicare?
Here are some options for getting home health services with Medicare:
Apply for Medicaid
You can apply for both Medicaid and Medicare as long as you meet the criteria. In most cases, you don’t even have to spend a dime as long as you meet Medicaid’s qualifying income level. If your income level is above the qualifying level, here are a few other options to consider.
Spending down typically involves paying for the difference between your income and Medicaid’s qualifying income level. For instance, if the income limit is $750 and you earn $1000, you can consider paying Medicaid the $250 difference. And in exchange, you get the policy’s programs and coverage.
This is the most popular option for people earning more than Medicaid’s income limit. Instead of spending down, consider enrolling in a pooled income trust.
Pooled Income Trusts are typically managed by non-profit organizations. The trusts act like managed bank accounts where you save your extra income. And in turn, the organization pays your bills and reimburses you for out-of-pocket expenses from your surplus income.
This option is especially suitable for anyone enrolled in a pension or Social Security plan because your bills and other associated expenses can still be taken care of without it affecting your lifestyle.
Pay Out of Pocket
If you don’t like the idea of anyone managing your money, consider paying out of pocket. The best thing about this is that you still get the same choices as CDPAP when it comes to choosing your caregiver.
Talk to Your Life Insurance Company
Most life insurance policies offer benefits that let you access part of your death benefits to cover long-term care costs. These benefits are typically available for consumers with chronic or terminal conditions. Alternatively, consider consulting your insurance provider if you have an older policy. That’s because they may offer long-term care coverage as an added benefit.
The Bottom Line
Medicare offers cost-saving benefits for short-term care. But you can still get home health benefits under specific circumstances.
For the best results, you should enroll in both Medicare and Medicaid. That’s because Medicaid may offer added coverage options that Medicare doesn’t offer. That said, you can always use the above mentioned alternatives if you don’t qualify for Medicaid coverage.