Medicare might cover your health care at home. This is if you need health care and are homebound. For instance, if you had an operation in the hospital and you need home health care assistance, then Medicare might pay for it. Normally, if you are under a Medicare-approved home health agency, it can sometimes be a replacement for nursing homes in the short-term
What do home health agencies do?
You will be able to receive care in the home with a home health agency. If you have a disability or medical condition, you can sometimes receive home health care services from these agencies. This is temporary and serves as a substitute for nursing home care. The following are some of the services you get during home health care, this will depend on the agency:
- Physical therapy
- Home health aide services
- Skilled nursing care
You may also learn how to care for yourself from these agencies.
If you need more information about home health agencies, then speak to your hospital discharge planner or your doctor. They can inform you whether care in the home fits your needs. Limited home health services is an option in many states as well.
Be aware to use this information in this article for informational purposes only. This is not a replacement for professional medical advice. If you have a health condition, speak to your medical provider about treatment or diagnosis.
Medicare coverage and home health agencies
A Medicare-certified home health agency will cover the care at home you need in some cases. Below are the requirements you need to qualify, all must be true:
- You cannot travel outside the home without help (homebound)
- You have Medicare under a doctor’s care.
- You will need one of these at minimum:
- Speech, physical or occupational therapy, according to Medicare guidelines and restrictions.
- Skilled nursing care (except drawing blood)
You cannot order these services for yourself, your doctor must order them. Please note Medicare covers certain services but you doctor may order more frequent or different services. If you want to know whether you will have to pay for any of the services your provider wants you to have, then contact your provider.
- Your care plan must be regularly reviewed and authorized by your doctor. A home health agency that Medicare certifies must provide part-time or intermittent (not constant) services to you. This excludes hospice care
- In certain cases, Medicare will cover medical social services, durable medical equipment (DME), and other services or supplies. If you want to find out what Medicare can cover for you, then talk to your hospital discharge planner or social worker. You can also call 1–800–633–4227 (1–800-MEDICARE; for TTY users, 1–877–486–2048) for this knowledge. You will owe an amount when all said and done as Medicare does not pay the total cost for these services. For instance you will pay 20% for the durable medical equipment (DME) expenses. There are expenses that Original Medicare (Part A and B) does not pay for, you can get a Medicare Supplement plan to pay for some or all of your expenses.
- Enrolling in a Medicare Advantage plan entitles you to the same level of services as in Original Medicare (Part A and Part B).
A List of Home care that Medicare will not cover
Medicare does not cover all care in the home. Here are the services it does not pay for:
- Housekeeping
- Constant care for 24 hours
- Personal care e.g. bathing
- Meals
- Long-term skilled nursing care
Caregivers as another option to home health agencies
The duty of a caregiver is increasing in number year after year. A caregivers job is to assist children with special needs, or take care of parents / spouses. The following is what they can help with:
- Giving medicine
- Bathing
- Food shopping and cooking
- House-cleaning
- Providing company and emotional support
- Paying bills
- Dressing
- And other personal care
Other options other than a home health agency
Below are other options to home health agencies aside from caregivers.
- Federal and state-subsidized senior housing programs for elders with low to moderate incomes. These programs can offer help to residents who need certain tasks done like laundry and shopping. If you want more information about this, contact your state Medicaid agency.
- If you live in an assisted living facility, then you may be able to get “assisted listing” arrangements. These services can involve reminders to take medications, cooking, or laundry. These assisted living facilities are typically not paid for by Medicare and can cost thousands of dollars per month.
- If you do not need nursing home services but cannot live independently, there are care and board homes. These homes are group living arrangements to match the requirements of the residents. The staff will typically help you with many daily living activities like walking, toileting, eating, and bathing. If you need help paying for this type of home care service, private long-term care insurance and medical assistance will help do just that. Medicare will not cover this living arrangement.