Imagine you fall and break your hip. Medicare covers most of your hospital stay and physical therapy, but when you return home, managing your daily routine is harder than you expected.
You can’t drive yet, and it’s difficult to stand long enough to cook dinner. Your daughter takes a few days off work and some friends stop by with meals for the first week, but then you’re mostly on your own.
Many older adults discover this too late, when they need some extra support and assume Medicare will help provide it.
Kendal at Home is designed to fill some of those gaps the additional support people often need to stay independent in the homes they love.
Here’s a closer look at what Medicare covers and leaves out when it comes to recovering from illnesses or injuries or more extensive long-term care and where Kendal at Home steps in.
Medicare fully covers a range of preventative care, including annual wellness visits, immunizations, screening for various types of cancer, and other appointments people may not realize, such as bone mass measurements or glaucoma screening.
Medicare typically covers hospital stays after someone has met their deductible, which is just over $1,700 this year, said Hans Engelhardt, CEO of Crescent Insurance, a brokerage firm that advises older adults in Northern Kentucky and the surrounding areas on Medicare and supplemental insurance plans.
It covers 80% of the cost of other expenses, such as specialists, outpatient surgeries, MRIs and chemotherapy.
Medicare is health insurance designed to treat an illness or injury.
It doesn’t typically cover long-term care or non-medical care, including the support you may need with your daily routine as you age, Englehardt said. To qualify for a part-time home health aide, you must already be receiving skilled nursing care and be unable to leave your home.
Many older adults need some extra support long before they reach that point.
About 70% of people 65 and older will need some type of long-term care, according to the Administration for Community Living and Administration on Aging. That could include arranging for services like meal delivery, personal care, or home maintenance.
The costs of that care can add up quickly.
On average, a private nurse costs $90 per hour, and a non-medical caregiver costs $35 an hour, according to Carescout’s latest cost of care report.
Long-term care insurance may offset some of this cost, but these policies are expensive and harder to qualify for the longer you wait.
Consider all the phone calls you’d need to make in the days and weeks after a serious fall.
Does your plan include someone to help you:
Kendal at Home helps you plan for healthy aging and gives you the support you need to make those plans
When you join, you are paired with a care coordinator who gets to know you and connects you with resources that help you stay healthy.
It also means you have someone to call when something unexpected happens.
Kendal at Home
Members can choose a plan that includes care coverage, with daily benefits based on the average cost of care where they live.
While long-term care policies often start paying only after a waiting period and eligibility requirements, Kendal at Home care coverage starts the day you join.
Your care coordinator will bring in the right services when you need them from a trusted network of providers so you don’t have the responsibility of vetting someone, paying them and finding a backup if they call off.
The chart below shows what Medicare typically covers and where Kendal at Home provides additional support and coverage if you choose it.
|
When you need... |
What Medicare may cover |
How Kendal at Home helps |
|
To return home after a hospital stay |
Hospital treatment and qualifying rehabilitation |
Your care coordinator helps plan your return home, coordinates needed services, and supports a smoother transition. |
|
A little extra help with everyday living |
Generally does not cover ongoing personal care or homemaker services |
Someone who already knows you helps arrange trusted support. Depending on your membership, care costs may also be covered. |
|
To make your home safer |
Limited coverage for certain medically necessary equipment |
Your care coordinator helps identify changing needs and connect you with resources to make your home safer. |
|
More significant care as your needs change |
Generally does not cover ongoing custodial long-term care |
Your relationship continues as your needs evolve, with help coordinating appropriate care and potential financial coverage based on your plan. |
|
Someone to help you make sense of it all |
Does not provide an ongoing personal care coordinator |
You have an established relationship with someone who understands your preferences, helps you evaluate options, and supports you through changing circumstances. |
Go back to when you broke your hip.
Imagine you had joined Kendal at Home three years earlier. Before you left the hospital, your care coordinator started making arrangements so you can recover in your own home. By the time you returned, they had one of their trusted partners ready to help you with laundry and cooking for a few hours each day.
Your coordinator also knew your medical history.
When you mention feeling dizzy during your second week at home, they knew that wasn’t normal for you and encouraged you to see a specialist. The specialist discovered you had atrial fibrillation, a condition you can treat with medication and ongoing support. Left untreated, it could have become more serious.
Every week, your coordinator checks in to make sure you have what you need. When you have questions about what Medicare covers, they help you find the answers.
When your adult children worried about you being at home alone, Kendal arranged for a medical alert bracelet at no cost.
Later, when you had questions about your hospital bills and the costs of your new medications, they knew who to call to make sure your Medicare benefits and supplemental coverage were properly applied.
Because you had this extra support at home, you heal faster. You're walking unassisted after a few weeks, much sooner than your surgeon anticipated.
A month later, your care coordinator encourages you to participate in a virtual program designed to help you improve your balance and prevent another fall.
They also complete a home safety audit and suggest updates like handrails and grab bars. You don't have to call around for quotes, because they already have a trusted provider in mind.
Medicare pays for your surgery and your therapy. Your care coordinator is there for everything in between, and you trust them because they already know what’s important to you.
The best time to plan for long-term care is before you need it, when you have the most options available to you. The longer you wait to join, the more you’ll pay for membership and the increased possibility you may not qualify.
Register for an upcoming seminar to learn how Kendal at Home membership works and whether care coverage is the right fit for you.