Is Home Health Care Covered Under Medicare?
Yes, it does. But as is the case with all things in the world of Medicare, obtaining coverage for home health care is not as straightforward as you would like it to be.
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Are You Eligible for Coverage for Home Health Care?
Medicare will pay for in-home skilled nursing care, physical therapy, and other services for individuals who are largely or completely homebound.
That’s the wrinkle here – to have your home health care covered, you have to genuinely need it. To receive coverage, you must meet these requirements:
- You must be homebound, meaning that you are not able to leave your home without considerable effort, without the aid of another person, or without a wheelchair, walker, or other mobility aid.
- A doctor, a nurse practitioner, or another medical professional must attest to the fact that you are homebound. That professional must have examined you in person.
- The medical professional who attested to the fact that you needed home health care must review your plan at regular intervals and attest that your needs have not changed. How often? Don’t worry, you will receive communications from Medicare telling you when your care provider must file reports. Those updates should stipulate the services you require, the frequency with which you receive them, and other information.
- The services must be prescribed by a doctor – in most cases, by your primary care physician. However, in some instances, services can be approved if they have been required by a health care provider to whom your primary care provider referred you. Example: Your primary care physician refers you to a cardiologist or other specialist, who certifies that you need home health care.
Who Can Provide the Services You Need?
The care must come from a health agency that has been certified and approved by Medicare. Presently, there are about 11,000 such approved care providers in the United States. Medicare’s care provider search tool lists Medicare-approved home health care providers in your area.
What Home Health Care Services Are Covered?
- Skilled nursing care, including services such as changing wound dressings, giving injections, and feeding through a feeding tube.
- Services provided by health aides, such as assisting with bathing, dressing or going to the bathroom.
- Occupational, physical and speech therapy, to restore or improve patients’ ability to perform everyday tasks, or to speak or walk after an illness or injury.
- Psychological and social services provided by professionals, including counseling for social or emotional concerns related to an illness or injury.
- Medical supplies and equipment, provided they have been prescribed by your primary care provider or specialists who are part of the Medicare-approved chain of care providers. Note that Medicare will pay for some equipment, including wheelchairs, by using a deductible amount; the patient will be responsible for paying 20%, 40% or another amount of coverage costs.
Will Medicare Keep Paying Indefinitely?
Theoretically, yes. But Medicare will only pay for up to 60 days of care at a time and once those 60 days are up, you will need to reapply and request continued coverage.
Are There Home Care-Related Services that Medicare Will Not Cover?
Yes, there are a lot of them, including:
- Custodial and home cleaning services.
- Shopping, cooking, doing the laundry, and other maintenance services.
- Running errands, delivering meals, and providing other non-health-related services.
- The installation of ramps, stair climbing devices, and other architectural renovations.
- Specialized vehicles equipped to help move people who have limited mobility.
Summary
Yes, those are a lot of restrictions. But we hope you have also noticed something positive . . . Medicare really will pay for a number of the costs of home health care. You and your loved ones can benefit, provided you know the rules.
At CoverRight, we’re here to help you find the right Medicare coverage that you deserve. Reach out today and start finding the best Medicare plan for you.
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