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Question from Greg: My wife has Multiple Sclerosis. She’s having mobility issues and is likely going to require some in-home care in the future. One of her primary needs is somebody to assist with bathing. I didn’t know if Medicare helps pay for a home care worker coming in once or twice a week to assist with personal hygiene. Can you advise please?
This question was just posed to me last week by a current client and there’s much more to discuss here than the just the answer.
My advice to everyone is never assume anything when it comes to what is covered by Medicare or not. And don’t take what a friend or family member might tell you as fact. When I got this question my first thought was, “I’ve never known this type of home health care (bathing, dressing, feeding, cleaning, etc.) to be covered by Medicare for any reason so I highly doubt it.”
However, I wanted to be 100% sure. I started my research with a Google search that led me to the National Multiple Sclerosis Foundation. There was a list of frequently asked questions and one was very similar to Greg’s. The answer wasn’t completely clear but gave me some hope that maybe his wife would be eligible for the care he was looking for. I then called the MS Foundation and was able to speak with a very helpful representative. She not only emailed me some information that indicated Greg’s wife would indeed most likely be covered by Medicare for in home care, but informed me that since Greg was his wife’s primary caretaker, they would qualify for their Respite Program which has a $1,000 stipend they can use to pay for some in home care to bridge the gap until Medicare approves the needed services, which could take some time.
Finding this information was not that difficult. In all I spent about an hour researching and talking on the phone. The tough part may be dealing with the huge bureaucracy that is Medicare, acquiring the application, and then getting it into the right hands for approval. The answer someone may get when calling such a large government organization to inquire about programs and procedures may depend on the person who answers the call and what kind of day he or she’s having. Persistence is the key in these situations. Our staff never accepts answers such as: “Well, I think it may be covered but I’m not sure.” “That’s just the way it is.” “I’ve never heard that before.” Or in this case, “No. It’s not covered.” When I, another agent, or a member of our support team is convinced our client is deserving of a benefit such as this, was a victim of erroneous billing, or been denied a medical service, we don’t stop making calls and filing appeals or complaints until the issue gets resolved. We’ve had several instances where it took as long as six months to get our clients refunds for premiums that were deducted by an insurance company that shouldn’t have been, erroneous bills, or what I would consider unethical billing practices. In some cases, the amount of the reimbursements was in the thousands of dollars.
I didn’t have someone there to teach me all the endless ins and outs of Medicare; the nuances, regulations, loopholes, programs to help clients, etc., when I first began this career. I learned by asking questions and making phone call after phone call until I got the right answer or found a solution for the client’s dilemma. And after 13 years in the business, I’m still learning like I did digging around trying to find the answer to Greg’s question.
What myself and the staff have discovered has helped hundreds, if not thousands of people we’ve met along the way. We’ve found foundations for those who were strapped with bills for Chemotherapy, medications in the “Doughnut Hole,” or other large expenses. We’ve come across little known loopholes and programs such as the Area on Aging’s Medicaid Waiver program and Medical Assistance for Workers with Disabilities (MAWD) that have much higher income limits than traditional Medicaid for those with certain physical limitations or medical conditions. Most people would be surprised just how much help and programs are available.
If you have any questions regarding this column or would like to make an appointment for a no cost consultation, please give one of our offices a call. I would also like to announce I’ll be doing a weekly podcast where I’ll get much more in depth on the latest column question and topic. You can find those on our website. Simply click on the podcast tab at the top of our page for the archived shows.
Be safe and stay healthy everyone!
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