Does Medicare Cover Home Health Care?
Yes, Medicare Part A and Medicare Part B do cover part-time home health care in specific situations. To be eligible for coverage, you must meet specific criteria, such as being home-bound and needing skilled nursing care or other medical services. However, there are limitations regarding the length of care, and some services, such as personal care assistance, may not be covered.
What Does Medicare Cover?
The covered home health services are:
- Skilled nursing care that is part-time or intermittent and medically necessary
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Home health aide care that is part-time or intermittent (only if you’re also receiving skilled nursing care simultaneously)
- Injectable osteoporosis drugs for women
- Durable medical equipment
- Medical supplies for home use
What is Not Covered?
There are certain medical expenses that Medicare benefits do not cover. These include:
- 24-hour care in your home
- Meals delivered to your home
- Homemaker services like shopping and cleaning that are not related to your care plan
- Custodial or personal care that only helps you with activities of daily living such as bathing, dressing, or using the bathroom
How Do I Get Home Health Care?
Suppose you need home health care services, and your doctor certifies that you are eligible for Medicare home health coverage. In that case, you will receive a written care plan outlining your required services, measurable goals, and other information.
Medicare covers 100% of the approved amount for home health services, with no copays or deductibles. However, the total coverage may vary depending on various factors such type of services required and the state that seniors reside in.
It is essential to note that Medicare coverage is not automatic, and seniors must take steps to receive the necessary benefits. These steps can include obtaining a doctor’s certification of the need for home health care, choosing an approved agency that accepts Medicare, and documenting all received care appropriately. Not adhering to specific criteria, such as the doctor’s orders, can impact the Medicare payment for received services.
What If I Don't Qualify?
Seniors who need long-term care may need to consider other options to cover the expenses not covered by Medicare. Medicaid, for example, may cover long-term care services, but eligibility varies by state. Furthermore, private health insurance companies may offer home healthcare coverage options such as long-term and short-term care insurance, which can help fill gaps in their original Medicare coverage.
Medicare will cover home health care in many situations, but there are eligibility requirements and restrictions. Understanding the specifics of Medicare coverage for home health care before seeking services is essential to ensure you receive the benefits you need and deserve. Additionally, seniors can explore other insurance options if they do not qualify for Medicare or need additional coverage beyond the original Medicare.
What is home-bound for Medicare?
Being “home-bound” for Medicare means leaving the home is exceptionally difficult due to medical conditions. Some criteria include being unable to leave home alone, requiring help from someone else to leave the house, or needing transportation assistance such as a wheelchair or walker. Medicare may also consider whether a person’s condition limits their ability to drive a car alone.
Does Medicare pay for help around the house?
If you meet specific eligibility requirements and your illness or injury requires it, Medicare can cover the cost of healthcare services in your home. The services must be deemed appropriate and essential for your treatment.