Does Medicare pay for a home health care provider?
Editor’s Note: Journalist Philip Moeller is here to provide the answers you need on aging and retirement. His weekly column, “Ask Phil,” aims to help older Americans and their families by answering their health care and financial questions. Phil is the author of the new book, “Get What’s Yours for Medicare,” and co-author of “Get What’s Yours: The Revised Secrets to Maxing Out Your Social Security.” Send your questions to Phil.
Cindy – Florida: My mom is in the final stages of ovarian cancer and is in hospice. The nurse comes out once a week and that is all they provide at this time. We are looking to get home health care during the day so that someone can stay with her and also provide very light help with meals. Does Medicare pay for this care if we hire a home health care provider?
Phil Moeller: I’m sorry to hear about your mom. Unfortunately, Medicare does not cover so-called custodial care. If your mom’s doctor thought at-home care was medically necessary, Medicare would cover someone providing interim care for a short period. But this would need to be medical in nature.
Mary Ann: I’m 44 years old and have been receiving Social Security Disability Insurance since 2008. I became a widow in 2012. Since my husband passed away, my son (born in July 2007) who has autism and my other son (born in July 1999) have both been receiving survivor benefits. They have both been receiving $1,500 each, and I am currently receiving $1,494 per month for my disability benefit. My 17-year-old son will be turning 18 this coming July, and the loss of his $1,500 benefit would really hurt us financially.
Will I be able to receive any survivor benefit this summer, even if I am currently receiving disability benefits? Might my youngest son’s benefit possibly be recalculated to where he gets to maximize my late husband’s Social Security allowable benefits?
Phil Moeller: I can’t begin to imagine how hard it is to deal with you and your son’s disabilities, Now, you also have to worry about losing an important benefit. I’m so sorry.
If I understand your question correctly, you are facing the loss of substantial income when your older son turns 18 and is no longer eligible for a child’s survivor benefit. If he will still be in high school when he turns 18, it’s possible in some cases for this benefit to continue until he’s 19, so I’d check on that.
Unfortunately, you will not be entitled to a survivor’s benefit until you turn 50, which is 10 years earlier than the earliest age at which non-disabled survivors can file. When you do file for a survivor benefit, your additional payment would equal the amount by which your survivor benefit exceeds your disability payment.
If both of your sons were collecting a benefit based on your late husband’s earnings records, their total benefits might have been reduced under Social Security rules involving what’s called the family maximum benefit, which is explained here. When your older son’s benefits end, any family maximum benefit limits should disappear, and perhaps your younger son’s benefits will increase. Also, his benefits will last as long as he is disabled and will not end when he turns 18.
I suggest you either call Social Security or set up a face-to-face meeting with a representative at your local Social Security office. Carefully review your filing options, and see what makes sense.
Patty – Connecticut: I read your updated Social Security book (thank you!), and I totally understand that I can restrict the scope of my Social Security application and collect half my ex-spouse’s benefit while allowing my own benefits to grow until I’m 70. I was born in 1951, was married more than 10 years and divorced for more than two years. When I went to the Social Security office, they said I didn’t need to file any “restricted application.” In fact, they never heard of it! I felt like I was about to become another horror story for your book! So, I haven’t filed yet. Help!
Phil Moeller: I am sorry, but not surprised that you encountered problems with Social Security. Don’t give up! You are within your rights here, and I urge you to try again.
Social Security’s official rules are contained in its Program Operations Manual System (POMS). So, if an agency representative tells you they don’t know about restricted applications, please direct them to the POMS page about restricted applications. In particular, look at Section D, which includes this description:
D. Policy for restricting the scope of the application
When a claimant is eligible for more than one benefit at the time of filing, he or she may, for any reason, choose to limit or restrict the scope of the application to exclude a class of benefits unless there is an exception. The reason may be to receive higher current benefits or to maximize the amount of benefits over a period-of-time, including the effect of delayed retirement credits (DRC).
If that doesn’t satisfy them, here’s the agency’s explanation of how restricted applications are permitted for people your age:
If you turn 62 before January 2, 2016, deemed filing rules will not apply if you file at full retirement age or later. This means that you may file for either your spouse’s benefit or your retirement benefit without being required or “deemed” to file for the other. In your case, you may also restrict your application to apply only for spouse’s benefits and delay filing for your own retirement in order to earn delayed retirement credits. However, if you turn age 62 on or after January 2, 2016, you are required or “deemed” to file for both your own retirement and for any benefits you are due as a spouse, no matter what age you are.
Chloe – Maryland: I lost my job and my company health insurance when I was 64. I went on Obamacare until I was 65 and then went on Medicare with a supplemental Medigap plan and a Part D drug plan.
I am now 66 and have just been hired by an organization that offers health insurance. They say that if I want to stay on Medicare, I must waive participation in their plan and pay for Medicare myself. They will not offer any funds to cover what they would have been covering for me under the company scheme.
I have been told that if I give up Medicare, I might not be able to get the supplemental insurance back when I finally do retire (which I have no plans to do any time soon).
Phil Moeller: First off, it would be illegal for your employer to provide you any financial support for staying on Medicare and waiving your new employer plan. Otherwise, employers could basically bribe people to drop their employer coverage in favor of Medicare, likely saving the employers a bundle and shifting those costs to Medicare and, by extension, taxpayers. So, while your employer’s position may seem unfair to you, there is a good reason for it.
As for your Medigap plan, what you’ve been told is not true. Because you are returning to work, you may drop your Medigap plan and later get a new plan without losing the guaranteed issue rights you had when you first became eligible for Medicare. Those rights require insurers to sell you most types of Medigap plans without charging you more for any preexisting condition.
“When losing employer coverage, not all plans will be available in all states on a guaranteed issue basis,” says a spokeswoman for UnitedHealthcare, a large Medigap insurer. “Specifically, insurers are not required to make Plans D and G available on a guaranteed issue basis when a beneficiary loses employer coverage.” Also, the guaranteed issue period in this case extends 63 days after losing employer coverage.
David – Texas: If I do a Social Security “file and suspend,” am I forced to enroll in Medicare? Or can I still keep my employer health insurance?
Phil Moeller: It’s no longer possible to file and suspend. This rule was outlawed last year.
However, filing for Social Security does not require you to get Part B of Medicare or other private Medicare insurance policies. So, you can keep your employer insurance so long as you’re actively working.
Getting Social Security benefits does require you to have Part A of Medicare, which covers hospital expenses and which charges no premiums to those who have worked long enough to qualify for Social Security benefits.
Part A can come in handy as secondary insurance to help pay for covered expenses that are not fully paid by your employer’s insurance plan. However, having Part A invalidates a person’s right to have a tax-advantaged health savings account, or HSA. If you have an HSA, you’d either have to not file for Social Security or look for another health plan where you work.