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Everything You Need To Know About Medicare in New York City

Graphic: Everything you need to know about medicare for older adults. COHME is a nonprofit home health care agency in New York City that enabling older adults to age at home comfortably with at-home care in Manhattan, Brooklyn, the Bronx and Queens.

Medicare, a federal health insurance program, plays a crucial role in ensuring that older adults have access to essential healthcare services. In New York City, home health care services are a lifeline for many older adults, enabling them to receive necessary medical attention and assistance in the comfort of their homes.

And while the need for Medicare is so widespread, the very few people understand how exactly it works – and how they can benefit from this program. Medicare plays a vital role in providing home health care services to older adults in New York City. Eligible individuals can access skilled nursing care, home health aide services, therapy, and more through this program.

However, understanding its limitations and staying informed about legislative changes are essential for making the most of this valuable resource in ensuring the well-being of older adults in New York City. Here’s what you need to know:

Doctor with a clipboard. COHME is a nonprofit home health care agency in New York City that enabling older adults to age at home comfortably with at-home care in Manhattan, Brooklyn, the Bronx and Queens.

What is Medicare?

Medicare is a government-sponsored health insurance program primarily designed for older adults aged 65 and older. However, it also covers certain individuals under 65 with disabilities or specific medical conditions. The program is divided into several parts, each serving different healthcare needs.

Who is Eligible for Medicare?

To be eligible for Medicare in New York City, individuals must meet certain criteria. The primary eligibility requirement is being 65 years old or older. However, individuals under 65 may qualify if they have been receiving Social Security Disability Insurance (SSDI) for at least 24 months or have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

How to Get Medicare for Home Health Care?

Enrolling in Medicare typically occurs during specific enrollment periods, such as the Initial Enrollment Period, Special Enrollment Periods, or the Annual Enrollment Period. To get Medicare coverage for home health care, older adults can follow these steps:

  • Determine Eligibility: Ensure you meet the age or disability requirements.

  • Apply for Original Medicare (Parts A and B): You can apply online through the Social Security Administration's website or visit a local Social Security office.

  • Consider Additional Coverage (Medicare Advantage and Part D): Original Medicare covers a portion of home health care expenses. Older adults can choose to enroll in Medicare Advantage plans or Part D prescription drug plans for more comprehensive coverage.

  • Select a Home Health Care Provider: Choose a nonprofit organization that offers home health care services. These organizations play a crucial role in connecting older adults with skilled home health aides.

What Medicare Covers in Terms of Home Health Care for Older Adults

Medicare covers a wide range of home health care services for older adults in New York City. These services include:

  • Skilled Nursing Care: Medicare pays for skilled nursing services provided by registered nurses or licensed practical nurses.

  • Home Health Aide Services: Home health aides, employed by nonprofit organizations, can assist with activities of daily living (ADLs) such as bathing, dressing, and meal preparation.

  • Physical, Occupational, and Speech Therapy: Medicare covers these therapies when they are deemed medically necessary for the older adult's recovery.

  • Medical Social Services: Social workers can provide counseling and support to older adults and their families.

  • Durable Medical Equipment (DME): Certain medical equipment, like wheelchairs or oxygen equipment, may be covered by Medicare.

What Medicare Doesn't Cover for Home Health Care

While Medicare provides comprehensive coverage for many home health care services, it's important to be aware of its limitations. Medicare generally does not cover:

  • 24/7 Home Care: Medicare only covers part-time or intermittent home health care, not round-the-clock assistance.

  • Homemaker Services: Services like house cleaning or meal delivery are not covered by Medicare.

  • Custodial Care: Help with activities like bathing and dressing, without a skilled nursing need, may not be covered.

Challenges Faced by Medicare in New York City Legislatively

Medicare faces several legislative challenges in New York City, as policymakers grapple with the evolving healthcare landscape. Some key challenges include:

  • Funding: Ensuring that Medicare remains adequately funded to meet the growing needs of older adults is an ongoing challenge. Budget constraints and the rising cost of healthcare pose significant hurdles.

  • Access to Care: Ensuring that older adults in all neighborhoods of New York City have equal access to quality home health care services is a priority. Addressing healthcare disparities is essential.

  • Legislative Changes: Medicare policies and regulations can change over time, impacting the coverage and services available to older adults. Staying informed about these changes is crucial.

Questions about whether you can use Medicare coverage for home health support from COHME? Give us a call at (212) 514-7147


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