About 75% of seniors wish to remain in their homes and age in place, according to the most recent data from AARP. However, many of these older adults believe they might be forced to move into a new home because they don’t have the features and resources to live safely and comfortably.
While there are currently concerns about the future of Medicare, there are also discussions that it might increase its coverage and potentially pay for certain renovations that support these seniors who decide to stay where they’re at instead of looking for a home for sale.
Here’s what you need to know about Medicare and home improvements for older adults.
What is Medicare?
Medicare is a federal health insurance program for people aged 65 and older as well as some adults with disabilities and chronic conditions, regardless of income. Medicaid, on the other hand, is a joint federal and state program that provides health coverage to low-income individuals and families.
Medicare continues to be a significant topic in political discussions, especially concerning its sustainability and the scope of coverage.
“What should it cover? What is right? What is fair? I see proposals on expanding benefits to include services like in-home care for seniors. It is a real tug-of-war between helping those needing help and overall fiscal responsibility, and it seems you can ask a thousand people and get a thousand opinions,” says Scott Speranza, CEO of HealthLock, a health care technology company that works with Medicare.
Former administrations advocated for Medicare to cover long-term home-care services, aiming to help seniors avoid nursing homes and support family caregivers.
“However, such proposals face debates over funding and implementation, reflecting the ongoing dialogue about how to best serve the aging population within fiscal constraints. But financial responsibility and helping those needing help are getting wrapped up in such a hot debate,” adds Speranza.
Who is eligible for Medicare?
Medicare is available to U.S. citizens or permanent legal residents who are 65 years old or older, have lived in the U.S. for at least five years, and have paid 40 quarters of Medicare payroll taxes. Spouses of those who qualify for Medicare coverage may receive it as well.
If you’re under the age of 65, you may be eligible for Medicare by being on Social Security Disability (SSD) benefits. You must collect SSD for two years before you can use your coverage. Also, if you receive disability pension from the Railroad Retirement Board or have been diagnosed with end-stage renal disease or amyotrophic lateral sclerosis, you’ll qualify for Medicare as well.
How can Medicare help homeowners stay in their homes?
“Medicare Part B covers certain durable medical equipment deemed medically necessary by a medical provider. Things like canes, walkers, wheelchairs, hospital beds, and patient lifts,” says Speranza.
Some home health agencies, which are certified by Medicare, might also come in handy as they can provide seniors with skilled nursing care; physical, occupational, and speech therapy; and personal care services.
However, Medicare does not typically cover home modifications, even if they would facilitate aging in place.
“Modifications like walk-in tubs, built-in shower benches, grab bars, pull-down cabinet shelves, and tap-to-open drawers are important for seniors who hope to continue life at home in their golden years,” says Judi Cooper, principal interior designer at Kitchens Inside Out.
Can Medicare cover home improvements to help those aging in place?
Even though Medicare covers durable medical equipment and home health care, it doesn’t pay for structural changes to the home environment and the vital home modifications many older adults need to age in place.
Unfortunately, this forces older adults who are often on a fixed income with limited funds to cover these costs out of pocket. Essentially, only those with serious medical conditions will receive some of the coverage they need.
Should Medicare cover home improvements for seniors?
Whether Medicare should pay for home improvements for older adults is a hot topic with no shortage of varying opinions. However, there are many politicians who are pushing for coverage.
“Medicare is essential to ensuring seniors have access to care, especially in rural and under-resourced communities,” said U.S. Rep. Raul Ruiz, a California Democrat. Ruiz, who is a physician, explained that Medicare reimbursement policies must match the increasing costs and administrative burdens we’re facing in the country today.
“I’m proud to support the Medicare Patient Access and Practice Stabilization Act, which will help make sure seniors have access to the care they deserve,” he added.
The Medicare Patient Access and Practice Stabilization Act of 2024 is a bipartisan bill that would wipe out previous legislation that enacted a 2.8% cut to the Medicare Physician Fee Schedule, or MPFS. MPFS is a list of fees that can be reimbursed for health care services, like the at-home ones discussed.