It’s important to plan for your health care needs, but sometimes life throws unexpected curve balls. And when that happens, you’ll need to know what’s covered. Fortunately, there are ways you and your loved ones can get the necessary care at home. Here’s what you need to know about in-home care for those with Medicare.
What is home health care and does Medicare cover it?
Home health care is a range of health care services given in your home for an illness or injury – like physical therapy or care from a home health aide. Medicare Part A or Part B covers these services at 100% for those that are eligible and if they’re required for treatment.
You might also need certain types of durable medical equipment, like a wheelchair or a commode chair. For these types of equipment, you’ll generally pay 20% of the Medicare-approved cost.
Home health care services covered by Medicare
- Skilled Nursing care (when given on a part-time or intermittent basis)
- Care from a home health aide (helps with daily activities if skilled care is needed)
- Medical social services (counseling, help finding community resources)
- Medical supplies (wound dressings)
- Necessary durable medical equipment (walker, wheelchair, hospital bed)
- Physical, occupational and speech language therapy
Home health care services not covered by Medicare
- 24-hour-a-day care at home
- Meal delivery
- Homemaker services (help with shopping, cleaning, laundry) – if this is the only care you need
- Personal or custodial care (help with bathing, dressing, using the bathroom) – if this is the only care you need
If you have a private Medicare health plan, check to see which home health care services are covered.
Who is eligible for home health care coverage?
Depending on your circumstances, Medicare covers certain in-home services. Those who have Medicare Parts A and B are covered by Medicare’s home health benefit when all the statements below are true:
- Your doctor says you need at least one of the following services at home (intermittent skilled nursing care, physical, speech-language or continued occupational therapy)
- You have a care plan that your doctor reviews regularly
- Your doctor confirms that you’re homebound (see definition below)
- You’re being cared for by a Medicare-certified home health agency
- You’re expected to improve within a reasonable period of time or you need a skilled therapist to improve your condition
What is Medicare’s definition of homebound status?
Medicare considers you homebound if both of these conditions are true.
- You need help when leaving home. This may be help from another person, durable medical equipment (like a walker or wheelchair) or use of special transportation. Alternatively, you have a condition such that leaving home is against medical advice.
- You must have an ongoing inability to leave home – not just for a day or two. Your trips out of home must be infrequent and short, because leaving home requires considerable effort and is very tiring.
Your doctor and home health agency (HHA) will evaluate your condition to certify if you are homebound. Every 60 days your doctor needs to re-evaluate and re-certify your care plan. If you aren’t declared homebound or recover from being homebound, you can receive medical care by visiting doctors and other health care providers. Or, you can take advantage of a remote care option like Virtuwell online clinic.
Being homebound doesn’t mean that you’re not allowed to leave home. You can still leave home for special occasions outside of health care, like religious services, family reunions, funerals, occasional trips to the barber or beauty parlor and more.