Home health care provides a range of medical services in the comfort of your own home, offering a convenient and often more affordable alternative to hospitals or skilled nursing facilities. Many people wonder about the cost of these services, especially when facing illness or injury. The good news is that if you are eligible, Medicare can significantly help cover the expenses of home health care.
Medicare Coverage for Home Health Care: What You Need to Know
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can cover home health services for eligible individuals who require part-time or intermittent skilled care. A key requirement for Medicare coverage is being considered “homebound.” This doesn’t mean you can never leave your home, but rather that leaving your home is challenging and requires considerable effort. You are generally considered homebound if:
- Leaving your home requires assistance due to an illness or injury. This could involve using mobility aids like a cane, wheelchair, walker, or crutches, needing special transportation, or relying on help from another person.
- Your doctor advises against leaving your home because of your health condition.
- You are generally unable to leave home without significant difficulty.
If you meet the homebound criteria and require skilled care, Medicare can cover a variety of home health services.
What Home Health Services are Covered by Medicare?
Medicare coverage for home health care is quite comprehensive, including medically necessary services ordered by a doctor or authorized health care provider and provided by a Medicare-certified home health agency. These services can include:
- Skilled Nursing Care: This involves part-time or intermittent skilled nursing services that are medically necessary. Examples include wound care for pressure sores or surgical wounds, patient and caregiver education on managing health conditions, intravenous or nutrition therapy, injections, and monitoring serious illnesses or unstable health status.
- Therapy Services: Medicare covers physical therapy, occupational therapy, and speech-language pathology services to help you regain or maintain your physical and communicative abilities.
- Medical Social Services: These services provide support and counseling to help you manage the social and emotional aspects of your illness.
- Home Health Aide Care: If you are also receiving skilled nursing care, therapy services, or medical social services, Medicare may cover part-time or intermittent home health aide care. Aides can assist with personal care tasks such as walking, bathing, grooming, changing bed linens, and feeding.
- Durable Medical Equipment (DME): Medicare covers durable medical equipment needed for your care at home, as well as related medical supplies.
- Osteoporosis Drugs: Injectable osteoporosis drugs for women are also covered under the home health benefit.
- Disposable Negative Pressure Wound Therapy Devices: These devices are used for advanced wound care and are covered by Medicare when medically necessary.
To initiate home health care under Medicare, your doctor or another health care provider must conduct a face-to-face assessment to certify your need for these services. They will also create a care plan and refer you to a Medicare-certified home health agency. Your provider is required to disclose if they have any financial interest in the agencies they recommend.
What Home Health Services are Not Covered by Medicare?
While Medicare offers substantial coverage for home health care, it’s important to understand what is not included. Medicare generally does not pay for:
- 24-hour-a-day care at home: Medicare is designed for part-time or intermittent care, not continuous, around-the-clock supervision.
- Home meal delivery: Meal services are not considered part of home health care under Medicare.
- Homemaker services: Assistance with tasks like shopping and cleaning that are not directly related to your medical care plan are not covered.
- Custodial or personal care: If you only require assistance with daily living activities such as bathing, dressing, or using the bathroom and do not need skilled medical care, this level of care is not covered under the home health benefit.
It’s also important to note that to qualify for Medicare home health benefits, your need for skilled care must be part-time or intermittent. While you can leave home for medical appointments or short, infrequent outings for non-medical reasons like religious services, needing more than intermittent skilled care may mean you don’t qualify for home health benefits. Attending adult day care is generally permitted while receiving home health care.
Understanding the Cost and Duration of Care
Medicare’s “part-time or intermittent” care definition generally means you can receive skilled nursing care and home health aide services for up to 8 hours per day combined, with a maximum of 28 hours per week. In certain situations, you might be able to receive more frequent care for a short period, up to 35 hours per week and less than 8 hours per day, if your provider deems it medically necessary.
By understanding what Medicare covers, you can navigate the costs associated with home health care and access the services you need to recover and maintain your health at home. Home health care, when covered by Medicare, can be a valuable and cost-effective option compared to facility-based care.
