Moeller: Medicare coverage for aging parents’ care is not nearly enough

A nurse and elderly man spend time together. | Courtesy of Jose Luis Pelaez, Inc./Blend Images/Corbis
Medicare doesn’t cover all types of home health care, which is something many elderly patients want. | Courtesy of Jose Luis Pelaez, Inc./Blend Images/Corbis

Medicare rules and private insurance plans can affect people differently depending on where they live. To make sure the answers here are as accurate as possible, Philip Moeller is working with the
State Health Insurance Assistance Program (SHIP). It is funded by the government but is otherwise independent and trains volunteers to provide consumer Medicare counseling in state and local offices around the country. The nonprofit Medicare Rights Center (MRC) is also providing on­going help.

Karen – W.Va.: My Mom is 88, and my Dad turns 90 this year. They have been relatively healthy until this past year when my Dad began to have small strokes and my Mom fell and broke her hip. She is now also struggling with cerebral amyloid angiopathy, which is causing many symptoms similar to a stroke. Both are disoriented, having severe difficulty with their long and short term memories and some trouble also communicating their thoughts. Neither of them is able to care for each other or themselves or are able to be left alone. My sister, who lives not far from them, has been looking after them almost 24/7 for the last seven months. I live at a distance, have many responsibilities in my life and can only come briefly from time to time. Our situation is not sustainable. In-home care is needed if they are going to remain in their home. Up until now, they have been living independently and would like to stay in their apartment, which they own. My sister says she has explored home care for them, but Medicare has told her they will only pay for skilled care, that is, nurses, rehab etc., which they have both used and Medicare did cover it. I read your qualifications in the PBS piece and my parents certainly qualify in the four categories you name, but my sister is hitting road blocks with Medicare who say they do not cover simple home care under any conditions. Am I understanding what you are saying correctly — do they have some home care in their Medicare coverage? If so how do we get around this roadblock? Who should we be talking to? Thanks so much for any help you can offer. We are quite desperate at this point.

Phil Moeller: This is one of the most significant real-life issues that growing numbers of older Americans and their grown children face. Millions of families will be in Karen’s situation. And we do not have the answers for them. Very few families can afford private long-term care insurance. Medicare certainly does not cover long-term custodial care in nursing homes or other institutional settings. Medicaid is the default provider of long-term care in this country. But older patients need to spend down nearly all of their assets to qualify for Medicaid, and the process of doing do is not only daunting in terms of paperwork, but often demeaning and embarrassing to proud Americans who have worked all their lives. They might be forgiven for feeling they deserve better than to be effectively forced into welfare to become wards of the state and placed in homes that, with all due respect, can easily become warehouses for the elderly poor.

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Philip Moeller

Journalist Philip Moeller, who writes widely on health and retirement, is here to provide the Medicare answers you need in “Ask Phil, the Medicare Maven.” Send your questions to Phil.

Moeller is a research fellow at the Center on Aging & Work at Boston College and co-author of “How to Live to 100.” He wrote his latest book, “How to Get What’s Yours: The Secrets to Maxing Out Your Social Security,” with Making Sen$e’s Paul Solman and Larry Kotlikoff. He is now working on a companion book about Medicare. Follow him on Twitter @PhilMoeller or e-mail him at

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