Is Home Health Care Covered by Medicare?

No matter how well a senior is doing currently, there will likely be a time when your loved one will need extra help or care at home. Whether it’s after recovering from a fall or learning new ways to go about daily routines and intensive therapies after a stroke, receiving care at home is possible. A number of agencies and organizations offer or provide home health care, and all with the intent of allowing a senior to receive the care they need without extended hospital stays.

However, many caregivers are concerned about cost when considering home health care. Some private insurances may cover costs, and some families will need to self-pay. And still others must combine several methods of private pay and insurance to get the right care at home.

One of the biggest questions we hear when it comes to paying for home health care is, “Does Medicare cover home health care?” The short answer is technically “yes,” but your loved one must meet a certain set of criteria for Medicare to cover their skilled care at home.

Is my loved one qualified to have their home health care covered by Medicare?

Is my loved one qualified to have their home health care covered by Medicare?

General guidelines: Is home health care covered by Medicare

Must be considered “homebound”

The individual must be considered “homebound” after an illness, fall, stroke or other medical situation. Homebound means that it is extremely difficult for the individual to leave their home, or that they must have help when they do.

Care must be considered intermittent

The care the individual needs must be considered “intermittent.” This means that your loved one does not currently need round-the-clock supervision or care. Intermittent also means that the care needed is predictable and finite (e.g. speech therapy after a stroke). For this reason, individuals with Alzheimer’s or late stage cancers will not qualify for this particular type of benefit because their care is more intensive, required 24/7 and will be needed for the foreseeable future.

Must need skilled care

The care must include the need for a skilled care, like the need for a skilled nurse or home health physical therapy.

How do I get Medicare coverage for home health care?

Steps for getting Medicare coverage for home health care

  1. In person appointment with primary care doctor

First, your loved one must have a face-to-face appointment with their primary care doctor within 90 days before home health care is started, or 30 days after home health care is started. This appointment can be in office, in hospital, or in some cases through videoconferencing.

  1. Certification from doctor about status and care plan

Next, the doctor will sign and certify that the patient is homebound and needs intermittent skilled care. The doctor will also certify that there is a care plan in place and that they saw the patient for this appointment.

For recertification, the doctor must review and re-certify the plan every 60 days. A face-to-face appointment is not needed for recertification.

  1. Find a Medicare-certified home health agency

Finally, you must receive care from a Medicare-certified home health agency, so research home health agencies in your area, check your benefits package or search for an approved home health agency on Medicare’s website.

How long does Medicare pay for home health care?

Medicare will pay for home health care over the period of 60 days. After 60 days, a patient must be re-certified by their doctor for intermittent home health care.

What does Medicare cover for home health care?

Medicare will cover short-term or intermittent skilled services like:

  • Skilled nursing (no more than 8 hours a day for a period of 21 days or less)
  • Physical, speech and occupational therapy from professional/skilled therapists
  • Help from home health aides in personal or grooming activities or light meal preparation, but only if this help is needed in relation to the illness or injury
  • Medical supplies needed for the patient’s condition (catheters, wound dressings)
  • Medical social services as related to your injury or condition (e.g. counseling for emotional or social concerns or community help if needed)

In short, if…

  • Your loved one is homebound and needs…
  • Short-term, intermittent and finite care from a skilled professional because of…
  • An illness or injury, and the care plan is necessary to…
  • Restore your loved one back to or close to their original mobility and health before the injury or illness…

…Medicare Part A and sometimes Part B will likely cover your home health care needs.

Please note that Medicare will not cover home health aides or help with daily tasks if that care is unrelated to an illness or injury (e.g. your loved one just needs a little extra help at home).

A reputable home health provider will help you understand costs during the initial assessment. They will also have staff members who will help you understand both insurance and Medicare plans and what is covered. Make sure you work with an organization you trust and who treats both you and your loved one with care.

In-Home Health Care Providers in Akron, Ohio

Our goal is to help seniors enjoy living at home for longer. My Family Home Health Care in Akron, Ohio offers a variety of in-home services after illness or injury recovery including skilled nursing and physical therapy. Let My Family take care of your family. Contact us today for an assessment.