It can be difficult for the Elderly or Disabled individuals to perform normal daily activities that most people take for granted. As a home health agency, our Personal Care Workers provide a service called Personal Care Services. This service is designed to assist clients/patients to successfully accomplish these normal daily activities. For more on Personal Care Services, please see: What are Personal Care Services?
Until recently, Medicare has not allowed Personal Care Services as a benefit. In the past, only traditional Medicaid and other Long-term Care Medicaid programs would offer the Personal Care Services benefit. CMS (Centers for Medicare & Medicaid Services) is now recognizing the need and importance of Personal Care Services. In 2019, CMS will be allowing Medicare Advantage Plans to offer Personal Care Services as a benefit. However, Traditional Medicare and Medicare Supplement Plans still will not offer the Personal Care Services benefit. Why Medicare Won’t Pay for Personal Care Services We have hopes that this will change soon, given the growing need for Personal Care Services.
As a Home Health Agency, we receive hundreds of phone calls annually from Medicare recipients who need Personal Care Services. It is very disconcerting when we explain to them that Medicare does not offer this service. Their only choice in the past was to privately pay for the service or see if they qualify for a Medicaid plan. The idea to allow Medicare Advantage Plans to offer Personal Care Services in 2019 is definitely a step in the right direction to getting the Elderly and Disabled individuals the help they desperately need in their homes
In any case, to qualify for the Personal Care Services benefit, the service must be medically appropriate. A Home Health Plan of Care must be developed with the help of your Physician. Your Physician must certify that you require Personal Care Services. Your Medicare Advantage Plan Insurance company will also verify that Personal Care Services are medically appropriate.
We should note that in Wisconsin, there are Home Health Agencies and Personal Care Agencies. Only Home Health Agencies can be Medicare Certified. So, if you have a Medicare Advantage Plan like a UnitedHealthcare Medicare Advantage Plan or AARP Medicare Complete, you will need to contact a Wisconsin Licensed Home Health Agency that is Medicare Certified for this service. This is all very new, and CMS is releasing additional information all the time. So, if you have questions please give us a call and we will assist you the best we can.
Do you have an updates on Medicare Advantage Plans offering updates?
Starting in 2019, CMS has allowed Medicare Advantage Plans to offer PCW services as an add-on to their plans. Some plans have begun to offer the service, but most haven’t yet in 2019. We receive a lot of calls from Medicare recipients asking for PCW services. There is a definite need for Personal Care Services, especially in the Medicare demographic. We believe that as Medicare recipients become more aware of the Medicare Advantage Plans that are offering PCW services, most Medicare Advantage plans will start to offer PCW services to stay competitive.