Aging in place is the concept of staying in one’s home throughout the aging process. It is a goal shared by many seniors.
To support aging in place, homes may require modifications to remain safe, comfortable, and accommodating.
Medicare offers some coverage for medically necessary home modifications to help seniors maintain their independence and enhance their quality of life.
In this post, we will explore the various ways Medicare can support seniors in adapting their homes for aging in place.
Understanding Home Modifications
Home modifications remove physical barriers within the home to help seniors more easily move around their homes and reduce the risk of accidents or injuries.
Examples of home modifications include:
- Installing ramps for wheelchair accessibility
- Adding grab bars in bathrooms
- Widening doorways to accommodate mobility aids like walkers and wheelchairs
- Installing non-slip flooring in high-traffic areas
- Installing chair lifts on staircases
- Pull-out shelves and drawers in cabinets for convenient reaching
Medicare Advantage Plans and Home Modifications
While Original Medicare (Part A and Part B) does not usually provide coverage for home modifications, some modifications may be partially covered for medical necessity.
- Seniors may explore additional options through Medicare Advantage (Part C) plans.
- Private insurance companies offer Medicare Advantage plans. These plans are approved by Medicare, and they often provide broader coverage and additional benefits beyond what Original Medicare offers.
- One of the valuable advantages of Medicare Advantage plans is their flexibility in providing extra benefits tailored to the specific needs of seniors. This may include coverage for services and items that can help you stay in your home
This is why, when considering Medicare Advantage plans, seniors should review the specific benefits and coverages offered by each plan. My Medicare Network, an non-government entity, can assist in helping you find the Medicare Advantage plan that best suits your needs.
The Process of Acquiring Medicare Coverage for Home Modifications
To access Medicare coverage for home modifications and assistive devices, seniors must meet specific criteria outlined by Medicare.
- In most cases, a written prescription or recommendation from their healthcare provider is required to initiate the coverage process. This prescription should clearly state the medical necessity of the modifications and how they will address the senior’s health condition.
- Engaging with occupational therapists is another required step in this process.
Medicare Part B provides coverage for occupational therapy services, where seniors work with skilled professionals to assess their needs and recommend appropriate modifications and devices tailored to their individual needs and health conditions.
Limitations and Out-of-Pocket Costs
While Medicare covers certain home modifications and assistive devices, seniors and their caregivers should be aware of coverage limitations.
- For instance, cosmetic enhancements or modifications that are not deemed medically necessary may not be covered by Medicare.
- There may also be out-of-pocket costs, such as deductibles, copayments, or coinsurance, for approved home modifications.
Understanding these limitations and costs can help seniors make informed decisions about the modifications they need and explore any available financial assistance options.
Additional Ways to Cover the Cost of Modifications
After reviewing Medicare and Medicare Advantage programs, seniors can look to the following to fund home modifications:
Local and state agencies, non-profit organizations, and community-based programs often provide grants or assistance for home modifications based on seniors’ income and need. Seniors can start by contacting their local Area Agency on Aging (AAA) or Department of Aging to inquire about available programs.
Seniors who qualify for both Medicare and Medicaid, commonly known as dual eligible individuals, may have more comprehensive coverage options.
Medicaid, jointly funded by the federal government and individual states, offers health coverage to low-income individuals, including seniors with limited financial resources. The eligibility criteria for Medicaid vary by state, but generally, seniors with limited income and assets may qualify for this program.
For dual-eligible seniors, Medicaid can help fill the gaps in coverage left by Medicare, including home modifications.
Veterans Affairs (VA) Benefits
Veterans who have served in the military and meet specific criteria may be eligible for home modification benefits through the Department of Veterans Affairs (VA). The VA offers several programs to assist veterans with service-related disabilities in making necessary home modifications.
One of the key programs is the Specially Adapted Housing (SAH) grant, which provides financial assistance to disabled veterans for home modifications that support their mobility and independence.
Another program is the Home Improvements and Structural Alterations (HISA) grant, which offers funds for home modifications to improve veterans’ daily living activities and overall well-being.
Following the correct process and obtaining the proper documentation will help seniors increase their chances of receiving Medicare or other financial coverage for home modifications so they can age in place.
As always, if you have questions regarding your Medicare coverage and eligibility–the team at My Medicare Network can help. Click this link to contact us to set up a no-cost consultation.