Medicare Annual Enrollment is here! October 15 -December 7. 
By Dr. Steve Evans
Caring for loved ones, especially those who have memory loss, dementia, or unstable heart disease can be stressful for caregivers and family members. It can be especially worrying after a hospital stay or outpatient procedure when members return home and need extra help.
Medicare has rules about what benefits a Medicare Advantage plan can provide in this situation. Medicare allows coverage for acute hospital care and then rehabilitation (or other complex nursing care) as part of a recovery or return to normal after the hospital stay. Acute care is basically short-term treatment for a severe injury, illness, emergency, or recovery from surgery.
Recovery can take place in a hospital, nursing facility, or at home, depending on the level of care a patient needs. Medicare rules generally specify where recovery can take place and for how long. While providers and Medicare Advantage plans have some flexibility in interpretation, the rules are pretty clear.
Outside of the Medicare-regulated recovery benefits, there are care options available that provide extra help to patients after a hospital stay or outpatient procedure.
As a caregiver, you’re likely helping the patient make these decisions. Some of the things to think about when reviewing the options are:
- How much will it cost?
- What kind of care is needed?
- How long is this care needed?
- How much can I do as a caregiver?
If, for example, your 82-year-old mom just had arthroscopic surgery to repair a tear in her shoulder and has to keep it immobilized, she might need some extra help around the house. Luckily you live close enough that you can help some, but you work and have a family and can’t be there every day.
HealthTeam Advantage has a unique custodial care benefit for members—it’s non-medical care from professional caregivers. These caregivers can help your mom with self-care tasks (eating, dressing, bathing); some household chores (cooking, picking up prescriptions, laundry); or mobility tasks like lifting and carrying items.
It covers up to 20 hours of care after a hospital stay or outpatient procedure and can be used three times per year (up to 60 hours). You can learn more about the benefit here.
Custodial care is a convenient way to transition from Medicare-ruled, medically necessary recovery or rehabilitation and getting back to normal. It can also help give caregivers some relief and peace of mind that your loved ones are getting the care they need at home.
Contact your Healthcare Concierge if you have questions or want to learn more about the Custodial Care benefit.
Dr. Steve Evans is a geriatrician and a Medicare Advantage medical director.
