With its mix of technical benefits and fees, health insurance isn’t the easiest to understand. The same can be said for Medicare — you want to be certain that the services you seek for a loved one are covered to avoid a pricey medical bill.
Medicare Parts A and B cover certain home health care services for those who qualify. However, some services that might seem like home health services are not covered. In this blog post, we identify those services and detail the requirements for eligibility.
What Is Home Health Care?
Home health care is defined as medical services provided in an eligible patient’s home to treat a chronic health condition or help a patient recover from an illness, injury or surgery. The primary goal is to help the patient recover and remain as independent as possible.
Generally, home health care begins after the patient experiences a decline in health or receives a diagnosis for a serious medical condition. In some cases, the patient transitions from a hospital, rehabilitation center or skilled nursing facility to home health care.
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Home Health Care Services
Home health care services address intermittent or periodic needs and may include:
- Nursing
- Therapies (physical, speech or occupational)
- Medical social work
- Wound care
- Patient and caregiver education
- Assistance from a home health aide
Home Care Services
Although similar in name, home care services and home health care services are different. Home care services generally help individuals with chronic illnesses or disabilities and those recovering from surgery with daily activities so that they can safely stay at home. Home care is also referred to as personal care, companion care, custodial care or homemaker services.
Generally paid for out of pocket, common home care services can include:
- Bathing, toileting, dressing and grooming
- House cleaning and chores
- Transportation
- Meal preparation
- Companionship
- Medication management
Learn more about the differences between home health care and home health to see which one best suits your loved one.
How Do I Qualify for Medicare Home Health Care Benefits?
If you’ve determined that home health care is the right type of care for yourself or your loved one, you’ll need to ensure that they meet a few qualifications. If you’ve identified an agency that provides home health care, ask if they are Medicare approved.
To be eligible for home health, a patient must:
Be Homebound
Homebound is defined by Medicare as being unable to leave a home without considerable effort or assistance from another person or device, such as a wheelchair or walker.
Receive Certification from a Medical Professional
Next, a medical professional will need to determine the need for one or more of the home health care services. This certification validates that the medical professional met with the person seeking care no more than 90 days before or 30 days after the start of home health care services.
Be Under a Care Plan
Finally, they will need to be under a care plan that is regularly reviewed by a doctor. The plan includes all required services and supplies and the anticipated length of care. Every 60 days, the doctor and home health team will review the care plan.
Which Services Are Included in Home Health Care?
If you or your loved one meets the criteria for home health care benefits, Medicare covers the following services, depending on each patient’s individualized plan of care:
Medical Social Services
Counselors address a patient’s social or emotional concerns related to the illness or injury while also receiving skilled nursing care. Social services can also help you find community resources, if needed.
Home Health Aides
Home health aides help with personal activities a person is unable to perform on their own due to an illness or injury, such as bathing, dressing or going to the bathroom. Frequency of services is determined by your healthcare team. Medicare covers these services if the patient is also receiving skilled nursing or one of the therapies listed below.
Skilled Nursing Care
On a part-time or intermittent basis, skilled nursing care is more active care, such as changing wound dressings, teaching and training disease specific care to reduce the risk of hospitalization and administering medication.
Occupational, Physical and Speech Therapies
Therapists work to restore or improve a person’s ability to perform everyday activities and speak or walk after an illness or injury. They also try to prevent worsening conditions.
For Medicare to cover this type of care, care can only be provided for fewer than seven days each work or daily for less than eight hours a day for up to 21 days.
Services Not Covered By Medicare
You or your loved one might need additional services that are not covered by Medicare and may require out-of-pocket expenses.
- 24-hour at-home care
- Personal care for assistance with daily living activities (if this is the only care needed)
- Household services unrelated to the care plan
- Meal delivery
How Long Do Medicare Home Health Care Benefits Last?
Most home health care is covered under Medicare Part A. In general, Part A covers a number of inpatient levels of care and home health care. However, at a certain point, Part A will switch to Part B.
Part A covers:
- Homebound patients
- If there is a skilled need for nursing or therapies
- If patient qualifies FTF within the time frames
If you still need home health care after Medicare Part A expires, Part B covers all additional approved services. Medicare Part B covers medically necessary services and certain preventive services. To qualify, the person must be homebound and need skilled care. However, a prior hospital stay is not required.
Find Out If Home Health Care Could Help
As the patient or caretaker for your mom, dad or family member facing the challenges of a chronic illness or injury, you might find yourself in an overwhelming position, especially if you don’t know where to turn for answers and support.
To help you understand the risk factors for you or your loved one, take our Home Health Care Assessment Quiz. After completing the quiz, you’ll receive a personalized report that will let you know if home health care is the best option.
