Oct 18, 2023

What does Medicare cover for in home care?

Manny Cominsky

When it comes to receiving medical care at home, many older adults rely on Medicare to cover the costs. However, understanding what Medicare covers for home health care can be confusing. In this comprehensive guide, we will delve into the details of Medicare coverage for home health care services. From skilled nursing care to therapy services, we will explore the eligibility requirements, covered services, costs, and limitations associated with Medicare's home health care benefits.

Eligibility for Medicare Home Health Care

To qualify for Medicare home health benefits, certain criteria must be met. Firstly, you must be under the care of a doctor who certifies the need for home health services. Additionally, you must be considered "homebound," meaning you have difficulty leaving your home without assistance due to an illness or injury. Homebound status may require the use of mobility aids or the assistance of another person. Lastly, your doctor must determine that you require intermittent skilled nursing care, physical therapy, occupational therapy, or speech-language therapy.

Covered Services under Medicare Home Health Care

If you meet the eligibility requirements, Medicare may cover a range of services for home health care. These services include:

Skilled Nursing Services: Medicare covers part-time or intermittent skilled nursing care provided by licensed or certified nurses. This can include wound care, medication management, and observation and assessment of your condition.

Skilled Therapy Services: Medicare covers physical therapy, occupational therapy, and speech-language pathology services that are reasonable and necessary for treating your illness or injury. Skilled therapists will help you regain mobility, strength, and communication abilities.

Home Health Aide Care: Medicare pays for a home health aide if you require skilled nursing or therapy services. Home health aides provide assistance with personal care activities such as bathing, toileting, and dressing.

Medical Social Services: Medicare covers medical social services ordered by your doctor to address social and emotional concerns related to your illness. This can include counseling and assistance in finding community resources.

Medical Supplies and Durable Medical Equipment (DME): Medicare pays for certain medically necessary supplies, including wound dressings and catheters. Additionally, Medicare covers 80% of the approved amount for DME such as wheelchairs or walkers.

Injectable Osteoporosis Medicines for Women: Medicare covers injectable osteoporosis drugs for women when prescribed by a healthcare professional.

Services Not Covered by Medicare

While Medicare provides coverage for various home health care services, there are certain services that are not covered. These include:

24-hour home care

Personal or custodial care, such as bathing or dressing assistance, when it's the only type of care needed

Domestic services like cleaning or meal delivery

Non-skilled home care services

It's important to note that Medicare primarily focuses on providing coverage for skilled services aimed at improving or managing specific medical conditions.

Cost of Home Health Care under Medicare

For eligible home health care services, Medicare covers the costs at no charge to you, as long as the services are considered medically necessary and meet Medicare's criteria. However, certain costs may apply. For durable medical equipment, Medicare covers 80% of the approved amount after you meet your Part B deductible. If you have a Medigap policy, it may cover some or all of the remaining 20% coinsurance.

It's worth mentioning that the cost of home health care can vary depending on factors such as location and specific services required. The national average cost of hiring a home health aide was $27 per hour in 2021, according to a survey by Genworth, an insurance company.

Requirements for Medicare Home Health Care Coverage

To receive Medicare home health care coverage, you must meet certain requirements. These include:

Doctor's Certification: A doctor or other healthcare provider must certify that you need home health services and establish a care plan.

Homebound Status: You must be considered homebound, meaning leaving your home is difficult and requires significant effort or assistance.

Need for Skilled Services: Your doctor must certify that you require intermittent skilled nursing care, physical therapy, occupational therapy, or speech-language pathology services.

Duration of Home Health Services

The duration of home health services can vary depending on your needs and the recommendation of your healthcare provider. Generally, Medicare covers home health services for as long as you meet the eligibility criteria and your doctor deems them necessary. However, skilled nursing care and home health aide services are typically provided on an intermittent basis, limited to a specific number of hours per day and week.

Understanding Medicare coverage for home health care services is crucial for older adults who require medical care in the comfort of their own homes. By meeting the eligibility requirements and having a clear understanding of the covered services, costs, and limitations, individuals can make informed decisions about their healthcare options. Medicare's home health care benefits provide essential support for those in need of skilled nursing, therapy, and other necessary medical services within a home setting.

To learn more about how Sunbound can help make senior care more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care and is on a mission to make senior living affordable for everyone.

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