Home health care encompasses everything from physical therapy to end-of-life hospice services and costs seniors in the US more than $123 billion annually, according to National Health Expenditure Accounts data. If you or a loved one needs home health care assistance, it is crucial that they understand how Medicare covers this form of assistance.
Medicare Part A and B both cover some forms of home health care services; for those with more complex needs it’s wise to consider Medicare Advantage plans with additional coverage in this area. Each plan may have unique rules regarding what qualifies as home healthcare services so check with each plan for more details.
Medicare typically only covers home health care that’s medically necessary and ordered by a doctor, such as wound care, physical and occupational therapy services, injections, IV therapy treatments, medication management programs and patient and caregiver education. Custodial care such as bathing or meal preparation or assistance getting dressed or going to the bathroom are not covered by Medicare.
Medicare Part A covers up to 100 days of home health care following hospital or SNF stays if you meet certain criteria, including being homebound and needing skilled level of care. In order to qualify, additional criteria may apply, such as being Medicare-approved homebound person and needing skilled level of care.
You may be eligible to extend this deadline if you can demonstrate that your need for home health care is temporary, such as following surgery or illness and needing more home health care than expected in recovery. Furthermore, an extension may also be granted if you’re still receiving treatments and can demonstrate that your condition has stabilized.
In order to receive home health care under Medicare, you must work with an approved agency that offers this service. These agencies should typically inform you which services will and won’t be covered, along with costs; and in cases where they recommend services which won’t be covered by Medicare they must give an Advance Beneficiary Notice (ABN) detailing these charges before providing these services.
Medicare will cover durable medical equipment and supplies for use at home, such as wheelchairs and nebulizers, up to 80% of their Medicare-approved amount; you must cover 20% coinsurance. Medicare Part C Advantage plans may have different rules regarding home health coverage; it’s wise to contact them to find out exactly what to expect.
Noting the limitations of Medicare-approved home health care should not be forgotten, especially as each period begins and ends; Medicare-approved home health agencies will provide you with a calendar showing when services will start and stop as well as any recommended extra supplies or services not covered by Medicare in advance.