S. 5270: Medicare at Home Act

This bill would create a new Medicare benefit for home care services for people who need help with daily living tasks and qualify for Medicare. In practical terms, it would let eligible Medicare beneficiaries get limited in-home assistance instead of having to rely only on unpaid family help, private-pay care, or Medicaid long-term care.

What services would be covered

The bill defines home care services as help provided in a person’s home by a home care worker under a care plan. Covered services would include:

• Help with activities of daily living, such as bathing, dressing, toileting, transferring, and eating
• Help with instrumental activities of daily living, such as meal preparation, medication reminders, and light housekeeping connected to the person’s health and safety

These services would be separate from Medicare’s existing home health services.

Who would qualify

A person would be eligible if they:

• Are enrolled in Medicare Part A or Part B
• Are certified by a doctor or other authorized practitioner as needing help with at least two daily living tasks, or one daily living task and one instrumental daily living task, or two instrumental daily living tasks
• Are not already receiving overlapping long-term services and supports through Medicaid that would duplicate this benefit

Limits on the benefit

The benefit would be capped at 20 hours per week per person. The bill describes it as a modest benefit rather than full-time long-term care.

How Medicare would pay for it

The bill would require Medicare to pay agencies or individuals enrolled under Medicare for these services. It also says the payment system should include a reasonable wage floor for home care workers.

How it would be financed

Because this would be a new Medicare benefit, the bill directs the Secretary of Health and Human Services to adjust the Medicare Part B monthly premium to cover the added cost. The exact increase would depend on actuarial estimates. Within 180 days of enactment, the CMS Chief Actuary would have to report the estimated premium impact to Congress.

When it would take effect

The Health and Human Services Secretary would have to issue implementing regulations within 1 year after enactment. The new benefit would begin on the first day of the first plan year that starts more than 2 years after enactment.

Relevant Companies

None found