Given the choice, the majority of individuals would rather recuperate in the comfort of their own home rather than stay in the hospital overnight.
With advancements in medical treatments and care, recovery from major surgery at home has become increasingly possible. Home health care offers a cost-effective and convenient alternative to services provided at hospitals or nursing care facilities.
[Read: 5 Steps for Picking a Medicare Plan.]
What Is Home Health Care?
Home care is a health service provided in the home to promote recovery, maintain independence and restore health or lessen the effects of illness and disability. Services may include home health aide, nursing care, rehabilitation therapy and personal care services.
Home health care provides “clinical” or “skilled” care by licensed nurses and therapists. Any service that you could get safely and effectively from a non-medical person, including yourself, without a nurse’s oversight is simply considered home care.
Certain medical supplies and durable medical equipment — like external defibrillators, which are crucial for assisting individuals during sudden cardiac arrest — are now compact and affordable enough to be available in the home.
[Understanding Medicare Eligibility for Individuals Under 65 With Disabilities]
Does Medicare Cover Home Health Care?
If you are signed up for original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), you can use your benefits to cover certain home health care.
Medicare covers skilled nursing and therapy services when your health care provider determines that the care you need requires the specialized skills of a nurse or therapist (such as giving certain IV drugs, some injections and tube feedings), changing dressings and teaching about prescription drugs or diabetes care.
Original Medicare covers the cost of several home health care services and medical supplies once certain requirements are met, including:
— You have trouble leaving your house unassisted due to an illness or injury and require assistance with a cane, wheelchair, crutches, specialized transportation or help from an individual.
— It’s not advised to leave your home because of your illness or health situation.
— It’s challenging to leave the home because it requires a major physical effort.
Home health services that are covered by Medicare, when ordered by your doctor, include:
— Part-time or intermittent skilled nursing care.
— Occupational therapy.
— Nutrition support.
— Speech-language pathology services.
— Part-time or intermittent home health aide care only if you’re also getting skilled nursing care at the same time.
— Injectable osteoporosis drugs for women.
— Durable medical equipment, such as canes, walkers and scooters.
— Medical supplies for use at home, such as blood sugar monitors, test trips and continuous positive airway pressure (CPAP) machines.
There are several care services that Medicare does not cover, including:
— 24/7 daytime care at home.
— Meal delivery services to your home.
— Homemaker services such as food shopping and cleaning.
— Custodial or personal care that helps you with daily living activities — like bathing, dressing, or using the bathroom — when this is the only care you need.
In most cases, “part-time or intermittent” means you may be able to get skilled nursing care and home health aide services up to eight hours a day with a maximum of 28 hours per week. You may be able to get more frequent care for a short time if your doctor or other health care provider determines it’s necessary and orders it for you.
[READ Does Medicare Cover Stair Lifts?]
How Do You Qualify for Medicare Home Health Care?
For an individual to qualify for home health care services they first must have a meeting with their doctor or qualifying health care professional to receive certification that they need such services. If they deem it necessary, they will place an order for the care with a home health care agency.
“To qualify for home care services, the individual must be considered homebound,” says Lance Slatton, a certified senior care manager and founder of All Home Care Matters podcast based in Livonia, Michigan. “There are exceptions to being homebound while receiving home health care. These exceptions are medical appointments, receiving a haircut at the barber or beauty salon, attending a funeral and or religious service, going outside for a short walk, graduation ceremonies, family reunions and the occasional special event.”
Does Medicare Cover In-Home Care?
Despite the abundance of information available, understanding the differences between home health care and home care can be challenging.
Below is a chart aimed at highlighting the significant differences and similarities in services covered:
| Home health care (skilled care) | Home care (non-skilled care) | |
| Original Medicare approved | Yes | No |
| Medicare Advantage approved | Yes, may vary depending on insurer | No |
| Medicaid approved | Depends on state | Depends on state |
| Skilled nursing | Yes | No |
| Rehabilitation therapy | Yes | No |
| Meal preparation | No | Yes |
| Activities of daily living (bathing, grooming, etc.) | No | Yes |
| Requirements for enrollment | Yes | No, unless enrolling in a Medicaid funded program |
Source: National Council on Aging.
How Long Will Medicare Pay for In-Home Care?
Medicare will pay the complete costs of individuals receiving home health care services when the individual is enrolled in Part A and Part B. If enrolled in a Medicare Advantage plan, the individual may incur out-of-pocket costs and may have limited access to home health care services.
Medicare Part A will cover the first 100 days of home health care after initially being admitted into the hospital or a skilled nursing facility. Medicare Part B will cover the additional services needed after Medicare Part A benefits expire.
“Under Medicare guidelines, the individual is required to be housebound and must receive home health care services within 14 days of their discharge,” Slatton says.
How to Find Home Health Care
Many hospitals and health care systems now offer their own in-house home health care services to make it more convenient to find qualified care.
“This can be a tremendous benefit to the patient having their care all within the same system,” Slatton says.
To find Medicare-certified home health agencies in your area, use Medicare’s official health care finder tool, which can provide families with information about how efficient the home health care companies are providing care for their patients.
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Does Medicare Cover Home Health Care? originally appeared on usnews.com
