You’re sitting in the hospital room, watching your loved one recover from surgery or an illness. Then the doctor says they need ongoing care, but you’re not quite sure how you’ll manage it alone. So, you start thinking about home health care. But there are things you’re not sure about, too. How will you pay for it? Does Medicare cover home care and home health care? Let’s cover them all today, from what services are included and who qualifies to how you can make the most of your benefits.
Medicare Coverage for Home Health Care
Home health care focuses on medical services that help you or your family member recover from an illness or injury. If your loved one is eligible, Medicare can cover a range of home healthcare services. But what does it take to qualify, and what services are included?
A. Eligibility Requirements
To be eligible for Medicare-covered home health care, you or your loved one must:
- Be under the care of a doctor
- Require intermittent skilled nursing care, physical therapy, or speech-language pathology
- Be homebound, meaning it’s difficult for them to leave their home
- Have a doctor’s order for home health care
B. Covered Services
Medicare covers a range of home healthcare services, including:
- Skilled Nursing Care. This covers skilled nursing care provided by a registered nurse (RN), licensed practical nurse (LPN), or home health care nurse on a part-time or intermittent basis. This can include wound care, medication management, and other medical services.
- Therapy Services. This covers physical therapy, occupational therapy, and speech-language pathology services to help your loved one recover from an illness or injury.
- Home Health Aide Services. This covers home health aide services, such as help with bathing, dressing, and using the bathroom, but only if your loved one requires skilled nursing care.
- Medical Social Services. This covers medical social services, such as counseling, help accessing community resources, and support to help you cope with your condition.
C. Duration and Frequency of Coverage
Remember that Medicare only covers home health care services on a part-time or intermittent basis, up to 28 hours per week. But, of course, the duration of coverage still depends on your loved one’s individual needs and medical condition.
Medicare Coverage for Home Care
While Medicare covers a range of home health care services, its coverage for non-medical home care is limited. This is because they do not cover non-medical home care services, such as homemaker services, personal care, or companionship. These services are not considered medically necessary and are not covered under Medicare.
There are circumstances where personal care might be covered, such as help with bathing or dressing. But only if they are provided with skilled nursing care or therapy services.
Costs and Payment
So, how much will you need to pay for home health care services?
- Medicare Part A and B Coverage: Medicare Part A (hospital insurance) and Part B (medical insurance) cover home healthcare services.
- Out-of-Pocket Expenses: You may need to pay 20% of the Medicare-approved amount for durable medical equipment, such as wheelchairs or oxygen tanks. You may also need to pay for services not covered by Medicare.
- Advance Beneficiary Notice of Non-Coverage (ABN): f Medicare denies coverage for a service, you will receive an Advance Beneficiary Notice of Non-Coverage (ABN). This notice explains why the service is not covered and provides information on how to appeal the decision. You’ll need to pay the total amount if you receive services that Medicare doesn’t cover.
How to Access Home Health Care Through Medicare
- Your doctor will determine if you need home health services and write a prescription.
- Research and choose an agency that meets your needs and is approved by Medicare.
Once you’ve got these in place, the home health agency will coordinate with your doctor and create a care plan tailored to your specific needs.
Speaking of a Medicare-certified home healthcare agency, Essential Wellness Florida is a dedicated provider committed to delivering exceptional care in the comfort of your home. With us, you can receive personalized care plans, skilled nursing, therapy services, and more.
KEY TAKEAWAYS:
- Medicare covers a range of home health care services, including skilled nursing care, therapy services, and home health aide services. Still, it does not cover non-medical home care services such as homemaker services, personal care, or companionship.
- To be eligible for Medicare-covered home health care, you or your loved one must be under a doctor’s care, require intermittent skilled nursing care, physical therapy, or speech-language pathology, be homebound, and have a doctor’s order for home health care.
- Medicare covers home health care services on a part-time or intermittent basis, up to 28 hours per week, and the duration of coverage depends on the individual’s needs and medical condition.
