Home health care services are health care services offered to you in the comfort of your own home and include things like physical therapy and nursing visits. Home health care services must be ordered by your doctor and are only covered by Medicare under certain conditions. Read on to find out how home health services are covered and to make the most of your benefits.
In order for Medicare to cover home health care you must meet the following criteria:
- Require skilled therapy or nursing care
- Be under the regular care of a doctor who is reviewing your progress and plan of care regularly.
- Be homebound. This means it is extremely difficult or impossible for you to attend outpatient appointments (as certified by your doctor)
When home health care services are ordered after an inpatient hospitalization (of a minimum of at least 3 days) they are covered under Medicare Part A, otherwise they are covered under Medicare Part B outpatient services. In a typical visit a nurse will do a basic exam, ask you questions about your overall health, diet and pain levels, as well as evaluating the safety of your home. Home health agencies may also be able to assist with coordinating your care and helping to connect you to any medical social services you may benefit from.
A home health evaluation and care plan should include all of the following:
- What services will you need
- Which health care professionals will be providing these services
- The frequency and proposed duration of services
- The medical equipment you may need
- What outcomes your doctor expects from your treatment
The following home healthcare services are covered by Medicare:
- Skilled nursing services which includes medical evaluations, IV therapy, injectables, wound care, tube feedings, catheter changes and evaluation and management of your care plan.
- Skilled therapy including physical (to help with walking, strength and overall movement), occupational (to help with dressing, eating and other activities of daily living) and speech (to regain speech and language skills)
- Home health aides are covered ONLY if you also require skilled nursing. These aides can assist you with activities of daily living such as bathing and dressing.
- Medical social services which includes support to help you deal with the emotional and social concerns you may have around your condition and can include counseling and help finding community resources
- Medical supplies such as wound dressings and catheters
- Durable Medical equipment such as wheelchairs and walkers
What services do not qualify as Medicare covered home health care:
- 24-hour-a-day care at home
- Meals and food delivered to your home
- Prescription drugs (except injectables)
- Homemaker services like shopping, cleaning, and laundry (except as a part of other necessary care)
- Custodial or personal care—like bathing, dressing, or using the bathroom (except as a part of other necessary care)
Home Health Care and Your Medicare Plan(s)
Original Medicare pays for 100% of qualifying home health services and up to 80% of prescribed durable medical equipment. If you have a Medicare Supplement Insurance plan it can help cover this unpaid portion. If you currently have Medicare Advantage your plan is required to provide the same home health care services at Original Medicare, though you may be subject to the following restrictions:
- Be required to choose a home health care agency that contracts with your plan
- Request and receive prior authorization from your plan before receiving care
- Pay a copayment for your care
No matter what plan you have, it is recommended that you ask the home health agency about what is covered and what your potential out of pocket expenses may be. If you are dissatisfied with care you can follow up with the agency or your doctor’s office.