Many people prefer to stay in the comfort of their own home to receive care for an illness or injury. If you or someone you are caring for is injured or ill and find it too difficult or uncomfortable to leave home for your health care needs, it may be necessary to have home health care services come to you.
Home health care agencies work closely with your health care providers to coordinate your health care needs. A skilled health care provider comes to your home to give you the care you need, so you do not have to travel to an office or hospital. Home health care can be a viable alternative to staying in a skilled nursing facility which may be more expensive or inconvenient.
If you require care at home, talk to your physician about your options and medical needs. Compare your options for home care and make sure you understand what will – and will not – be covered by your Medicare benefits.
Does Medicare Include Coverage for Home Health Services?
Medicare Part A (hospital insurance) includes coverage for home health care, but you must meet specific criteria in order to qualify. Home health services covered by Part A may include:
• Skilled nursing care on a part-time basis or on isolated occasions
• Physical therapy, occupational therapy, and speech-language pathology
• Medical social services
• Home health aide services for hands-on care on a part-time or intermittent
• Medical supplies necessary for home care
Medicare coverage does NOT include the following:
• 24-hour home care
• Meals delivered to the home
• Homemaker services like cooking or cleaning
• Personal care like dressing, bathing, or using the bathroom if this is the
only care needed
Are You Eligible for Home Health Care Services?
If you are a Medicare recipient who has coverage with Medicare Part A, you may be eligible for home health care services if you meet all the following requirements:
At the time of application, you are under the care of a physician and receiving services through a care plan that your physician has created and is reviewing regularly.
You have been certified by a health care provider as needing one or more of
the following services:
- skilled nursing care (intermittently)
- physical therapy
- speech-language pathology services
- continued occupational therapy
You must use a home health service agency that is certified by Medicare and physician has to certify that you are homebound due to your condition. According to Medicare regulations, you can be certified as homebound if your physician is concerned that your health may worsen if you leave your home. Another reason for certification is if you require assistance from another person, or from mobility aids such as crutches or a wheelchair in order to leave your place of residence. Your physician can certify you as being homebound even if you do leave home for short periods of time. The reason for leaving may not be medically related, though. It can be for reasons such as attending adult day care or religious services, for example.
Your Costs for Home Health Care Through Medicare
For eligible Medicare Part A recipients, the coverage for home health care is 100 percent of the cost that is provided by a Medicare-approved agency.
Medicare Part B also pays for 80 percent of the approved cost for durable medical equipment (DME) that is ordered by your physician for use in your home.
If you, or a person you are caring for needs home health care services, you should discuss details with the home health agency that you choose. You should ask them to inform you exactly what Medicare covers before you begin the service. Know which items or services you receive are included in your Medicare coverage and what out-of-pocket expenses you can expect.