Home health care offers a spectrum of medical services conveniently delivered in your home, ideal for recovery from illness or injury. Often more affordable, more convenient, and equally effective compared to hospital or skilled nursing facility (SNF) care, it’s a valuable option to consider.
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) provide coverage for eligible home health services. This coverage is available if you require part-time or intermittent skilled services and meet the definition of being “homebound.” Being homebound, in Medicare terms, means:
- You find it challenging to leave your home without assistance due to an illness or injury. This assistance could involve aids like a cane, wheelchair, walker, or crutches, special transportation, or help from another person.
- Leaving your home is medically inadvisable due to your current health condition.
- Leaving home is a significant effort and you are generally unable to do so.
What Home Health Services are Covered by Medicare?
Medicare-covered home health services encompass a range of necessary medical supports, including:
- Skilled Nursing Care (Part-Time or Intermittent): This includes medically necessary skilled nursing services provided on a part-time or intermittent basis, such as:
- Wound Care: Specialized care for pressure sores or post-surgical wounds, ensuring proper healing and preventing infection.
- Patient and Caregiver Education: Comprehensive education for both patients and their caregivers on managing health conditions, medications, and self-care techniques.
- Intravenous (IV) or Nutrition Therapy: Administering medications or nutritional support directly into the bloodstream when oral intake is insufficient or not possible.
- Injections: Administering prescribed injections as part of a treatment plan.
- Monitoring Serious Illness and Unstable Health Status: Regular monitoring of vital signs and health conditions that are serious or fluctuating, ensuring timely intervention and management.
- Physical Therapy: Therapeutic exercises and treatments to help restore mobility, strength, and function after illness, injury, or surgery.
- Occupational Therapy: Therapy focused on improving your ability to perform daily activities, enhancing independence at home and in your daily life.
- Speech-Language Pathology Services: Addressing speech, language, and swallowing difficulties to improve communication and safe eating.
- Medical Social Services: Providing counseling and support services to help patients and families cope with the emotional and social challenges related to illness and treatment.
- Home Health Aide Care (Part-Time or Intermittent): Personal care assistance provided on a part-time or intermittent basis, but only when you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy concurrently. Home health aide services can include:
- Help with Walking: Assistance with ambulation and mobility around the home.
- Bathing or Grooming: Support with personal hygiene tasks.
- Changing Bed Linens: Maintaining a clean and healthy environment.
- Feeding: Assistance with eating, if needed.
- Injectable Osteoporosis Drugs for Women: Coverage for injectable medications to treat osteoporosis in women at risk of fractures.
- Durable Medical Equipment (DME): Coverage for medically necessary equipment for use at home, such as wheelchairs, walkers, or hospital beds.
- Medical Supplies for Use at Home: Coverage for necessary medical supplies required for your home health care.
- Disposable Negative Pressure Wound Therapy Devices: Coverage for specialized wound care devices used at home.
How to Access Medicare Home Health Care
To initiate home health care under Medicare, a few key steps are necessary:
- Face-to-Face Assessment: A doctor or a qualified health care provider (like a nurse practitioner) must conduct a face-to-face assessment to confirm your need for home health services.
- Doctor’s Order: Your doctor or health care provider must formally order your home health care plan.
- Medicare-Certified Home Health Agency: The home health services must be provided by a home health agency that is certified by Medicare.
Your health care provider should provide you with a list of Medicare-certified agencies in your area. It’s also important for them to disclose if they have any financial interest in any of the listed agencies. You can also find agencies in your area through Medicare’s Care Compare tool.
Understanding the Duration and Frequency of Care
“Part-time or intermittent” care generally allows for skilled nursing care and home health aide services for a combined total of up to 8 hours per day, with a maximum of 28 hours per week. In certain situations, you might be able to receive more frequent care for a short duration, up to 35 hours per week and less than 8 hours per day, if deemed medically necessary by your provider.
What Medicare Home Health Care Does Not Cover
It’s important to understand the limitations of Medicare home health care coverage. Medicare does not pay for:
- 24-Hour-a-Day Care at Home: Medicare does not cover continuous, around-the-clock care in your home.
- Home Meal Delivery: Meal delivery services are not covered under home health care benefits.
- Homemaker Services: Services like shopping and cleaning that are not directly related to your medical care plan are not covered.
- Custodial or Personal Care (as primary need): If you solely require custodial or personal care to assist with daily living activities such as bathing, dressing, or using the bathroom, and do not need skilled care, you won’t qualify for the home health benefit.
Eligibility for home health benefits is contingent on needing no more than part-time or “intermittent” skilled care. You are permitted to leave home for medical treatments or short, infrequent outings for non-medical reasons, such as attending religious services. Participation in adult day care programs does not disqualify you from receiving home health care.
This guide provides a comprehensive overview of Medicare Part A And B Home Health Care benefits, ensuring you are well-informed about your coverage options.
