If you've been reading about Medicare's GUIDE program and then found out your mother is on a Medicare Advantage plan, you already know the disappointing part. GUIDE is for traditional Medicare only.
That's a dead end for GUIDE. It isn't a dead end for getting help.
Why Medicare Advantage is excluded
GUIDE pays approved Dementia Care Programs directly through traditional Medicare. The payment structure doesn't currently extend to Medicare Advantage plans, so anyone enrolled in one, including a Special Needs Plan, can't join.
Whether to change plans is a decision for you and a licensed Medicare advisor. It isn't something a home care agency should be advising you on, and we won't.
Check what your plan already covers
This is the step most families skip, and it's worth an afternoon.
Medicare Advantage plans can offer supplemental benefits that traditional Medicare doesn't. Some include in-home support services, help around the house, meal delivery, transportation to appointments, or caregiver support. There's also a category called Special Supplemental Benefits for the Chronically Ill, which some plans use to fund practical help at home for members with a qualifying condition.
The catch is that this varies enormously from plan to plan, and plans change what they offer each year. Yours may include a useful amount of in-home support or none at all.
How to find out: look at your plan's Evidence of Coverage document, which the plan sends every fall, or call the member services number on the back of the card and ask directly whether the plan covers in-home support services or personal care. Ask what the annual limit is and whether a referral is needed.
Families are often surprised by what turns out to be sitting in the plan already.
Medi-Cal and IHSS
California runs In-Home Supportive Services, which pays for help at home for people who qualify financially. Hours are assessed by the county based on what someone actually needs help with.
It works alongside Medicare Advantage. Being on an MA plan doesn't rule you out.
The application takes time, so it's worth starting before you're in a crisis rather than during one. Contact your county's IHSS office to begin.
Veterans benefits
If your parent or their late spouse served, Aid and Attendance adds a monthly amount to a VA pension for veterans who need help with daily activities.
It's underused, mostly because it isn't well advertised and the application looks intimidating. An accredited VA claims agent or a county Veterans Service Office can help, usually at no cost.
The policy nobody remembers buying
Long term care insurance. If a policy was bought twenty years ago, there's a reasonable chance it covers in-home care and the family has forgotten it exists, or assumes it only pays for a facility.
Find the policy and read the in-home care section, or send it to someone who'll read it for you. This is the single most overlooked source of funding we see.
Private pay, and why it's less frightening than it sounds
Most families who end up paying privately start much smaller than they expected to.
They don't need somebody all day. They need the two or three stretches of the day that have become difficult, and for most families that's mornings. Getting up, washing, dressing, breakfast. A few hours in the right part of the day solves most of the problem for a lot less than people assume when they first pick up the phone.
The honest way to find out what you'd actually need is to have somebody come and look.
Where to start
A free in-home assessment costs nothing and there's nothing to sign. Someone comes to the house, looks at the real situation, and tells you what would genuinely help and roughly what that would involve. Our article on what happens at a free in-home assessment walks through the visit step by step.
If one of the routes above fits your family better than paying privately, we'll tell you that too.
Call (916) 333-0383 in Greater Sacramento or (619) 430-4443 in San Diego County.
This article is general information for families and is not medical, legal, financial or insurance advice. Benefits, eligibility and program rules vary by plan and by county and may change. Check with your plan, your county or a licensed advisor about your own situation.
How Golden Years helps
Golden Years is family owned and has helped California families since 1996. Our caregivers are our own W-2 employees, and a care manager oversees every care plan. We provide personal home care for the hard parts of the morning, companion care for company and errands, and veterans home care for families using VA benefits.
Whatever your parent's plan, start with a free in-home assessment. We'll look at what's really happening at home and help you work out whether a few hours of support, dementia care, Alzheimer's care at home or 24 hour home care is the right fit. Licensed Home Care Organization #344700040.
