Expansion of Medicare Home Care Coverage on the Table With Harris Announcement

During an interview on the show, The View, Vice President Kamala Harris announced that, should she win the presidential election on November 6, she would aim to expand Medicare such that the government insurance primarily aimed at retired adults would cover long-term care at home. This would mark a significant expansion of Medicare that could affect millions of people.

Medicare and Long-Term Home Care

Medicare is a health insurance that is aimed at adults who are aged 65 years or older, but adults with disabilities can also enroll if they have a disability, with automatic enrollment based on when an older adult retires.¹ Medicare includes Part A, Part B, and Medicare Advantage, otherwise known as Part C. Medicare Cost Plans and Program of All-inclusive Care for the Elderly plans are also options for patients. Each plan comes with different coverage based on the needs of the patient.² However, Medicare does not cover some vital areas of care, including eye exams, hearing aids and exams, routine physical exams, most dental care, and long-term care.

Long-term care is an area of care that is of import, as almost 1 in 5 Americans aged 65 years and older are not able to do basic activities, like bathing, dressing, and eating, without some form of assistance.³ This number increases as an adult is aged 85 years or older, with nearly half of these older adults needing assistance. More than 37 million people in the United States provide unpaid care for an older family member, of which 59% are women, representing an unmet area of need for adults with older parents or family members.

The new proposal from Vice President Harris could help adults caring for both their older family members and their children | Image credit: Jade Maas/peopleimages.com

Cost of providing in-home long-term care services is estimated at more than $288,000 per year according to the Kaiser Family Foundation.⁴ This can amount to up to $40 per hour for a companion for an older adult and $38 per hour for a certified aide.⁵ Paying for an aide to live with an older adult can cost as much as $325 per day, which can add up for adults who are caring not only for their older adult family members but also their young children. As Medicare stands, long-term care services at home are not included, with the only public support for this care being through Medicaid and only available to older adults of low income, with coverage varying by state.

A Proposal to Help All Adults, But How?

Harris’s proposal would seek to change that. Harris proposed that Medicare could cover all of the costs of long-term care at home. The proposal could cost as much as $40 billion.

Such a proposal cannot be acted upon without Congressional support. However, past moves in this direction have been stopped, with some claiming that the cost for such care would be too great.³ Other challenges include the need to measure the need of home care by measures of functioning rather than blood work or lab tests, a way to indicate the need for Medicare coverage that is not reliant solely on income level, avoid overspending for care centered at home, regulating family members of older adults who are caring for them at home, and using Medicaid savings to supplement costs of the Medicare program for home care.

These challenges can pose major discussion points should Congress be tasked with passing a bill to advance the proposal. The goal will be to balance all of these challenges at the same time as older adults are benefitted. In an article published by Brookings Institute,³ the authors proposed that a conservative design for a universal program was possible by focusing on certain factors. Creating universal criteria for how patients can qualify for the program would be helpful and could include tests on how many independent activities of daily living that an older adult can perform, which is a method of testing already used by Medicaid.

Current income and accumulated assets may also be used as a way of calculating beneficiary contributions through cost sharing. People’s means would be taken into consideration to include cost-sharing, which would allow people with fewer assets and less income to pay less than those with high income and assets. The authors also proposed that only professional home caregivers would be compensated for home health care, with hours of support calculated by need. Defraying the costs of the program could also be done by shifting home care benefits from Medicaid to Medicare to produce Federal Medicaid savings.³

Harris’ proposal, should it find Congressional support, would need to incorporate these ideas to prove effective, according to Brookings. In its current form, Harris plans to expand Medicare drug price negotiations and reduce hidden costs associated with pharmacy benefit managers to pay for the program.

According to Tricia Neuman, senior vice president and executive director of the Program on Medicare Policy at Kaiser Family Foundation, this proposal is the first time in decades that a presidential candidate has proposed expansion that would help adults caring for their older parents or family members. Whether or not policy to make this change is passed, the discussion of these methods of relief is new territory and could indicate a new direction that Harris and other Democrats are looking into as part of their greater health care plan.

Resources

1. Get started with Medicare. Medicare.gov. 2024. Accessed October 9, 2024. https://www.medicare.gov/basics/get-started-with-medicare
2. What’s not covered? Medicare.gov. 2024. Accessed October 9, 2024. https://www.medicare.gov/providers-services/original-medicare/not-covered
3. Glied S, Frank RG, Gruber J, Agarwal V, Primus W. A home care benefit for Medicare. September 20, 2024. Accessed October 9, 2024. https://www.brookings.edu/articles/a-home-care-benefit-for-medicare/
4. Nova A. Harris proposes expanding Medicare to cover long-term care at home. October 8, 2024. Accessed October 9, 2024. https://www.cnbc.com/2024/10/08/harris-universal-long-term-care-at-home-medicare-trump-election.html
5. Home care costs. Homeworks. 2024. Accessed October 9, 2024. https://umcommunities.org/homeworks/cost-of-home-care-for-elderly/