Are you getting ready to turn 65 and eligible for Medicare? If so, you might be wondering what home health services are covered. Luckily, Medicare covers a variety of services that can help you stay healthy and comfortable in your own home.
This blog post will give you a breakdown of the different home health care services that Medicare covers and does not cover. Also, we will discuss the eligibility criteria as each person’s situation is different. So, keep reading to learn more!
What are home health services?
Home health care services provide a wide range of medical assistance to individuals at their residences instead of in hospitals or nursing homes. This type of assistance is designed to help individuals manage their health and wellness, promote independent living, reduce the risk of injury or illness, and provide assistance with activities of daily living due to chronic conditions. Home health care services can be categorized into the following types:
1. Basic assistance
Home health services provide assistance with personal care and homemaker services. For example, they may help with getting out of bed, checking home safety measures, helping with meal preparation, maintaining hygiene needs, and similar tasks.
2. Therapies and counseling
Home health care provides physical, occupational, or speech therapies with professional caregivers to people recovering from an injury or illness. They also offer counseling to individuals dealing with trauma or mental health issues.
3. Skilled nursing care
Skilled home health services provide nursing assistance to people requiring an advanced level of care and supervision. They do medication management, regular health checkups, administer injections, and provide nutrition therapies.
4. Doctor supervision
Doctor visits are provided to those dealing with a serious illness or injury and needing constant monitoring. In this situation, a physician pays visits to the patient’s home for regular health checkups and reviews medication and home health care needs.
What home health services are covered by Medicare?
Medicare covers an array of home health services for eligible individuals. Here are the home health services covered by Medicare under its part A and part B coverage:
1. Skilled nursing care
Medicare covers skilled nursing care provided by registered nurses or certified nursing assistants. Their services include injections, medication administration, wound care, tube feeding, assessing care plans, and similar services. Medicare usually covers 28 hours of care per week but may go up to 35 hours in some cases for up to three weeks.
2. Skilled therapy services
Skilled therapy services such as physical, occupational, or speech therapies are also covered under Medicare part B. Physical therapy focuses on restoring a patient’s mobility, occupational therapy helps patients develop skills related to daily living activities, while speech therapy focuses on improved communication. All these services help the patient recover from an injury or illness and regain their independence as much as possible.
3. Home health aides
Home health aides provide personal care assistance, such as help with getting out of bed, bathing, and using the restroom. They can also help with instrumental activities of daily living (IADLs). For example, grocery shopping and cooking meals. Medicare pays for this service in full, but you must be under skilled nursing care or therapies to be eligible.
4. Medical social services
Medical social services are another home health service covered by Medicare in certain situations. These services can help address any social or psychological issues affecting a patient’s recovery from an illness or injury. Medical social workers also assist patients in accessing resources in their local community, such as transportation services or local support groups.
5. Medical equipment and supplies
In some cases, Medicare part B will cover the cost of durable medical equipment necessary for a patient’s recovery at home. It could include wheelchairs, hospital beds, catheters, and similar supplies provided by home health agencies approved by Medicare. Medicare might also cover certain home modifications made to make life easier for patients with physical disabilities, such as installing grab bars in the bathroom or widening doorways for wheelchair access.
Home health services NOT covered by Medicare
Though Medicare in-home care covers several services, it is important to remember that it does not provide coverage for all types of home health services. The home health services not covered by Medicare include:
- 24/7 home care services or personal care services
- Non-skilled care such as housekeeping, running errands, laundry, and other similar activities
- Long-term care services such as nursing home stays and assisted living facilities
- Meal delivery services or transportation services
- Any other non-medical service or equipment
Medicare home health care eligibility criteria
To be eligible for Medicare health aid, an individual must meet certain criteria. That includes:
- They must be enrolled in Original Medicare plan
- Must have a written plan of care from a doctor that orders skilled medical services to be provided at home
- The person has to be homebound due to injury or illness
- They must be receiving one of the following services – intermittent skilled nursing care; physical therapy; speech/language therapy; occupational therapy; medical social services; or part-time home health aide services
- The patient is expected to recover or make some progress over a period of time
To learn more about the Medicare home health care eligibility criteria, visit their official page.
- Medicare will cover home health care costs as long as they are medically necessary.
- Medicare covers the full cost of skilled home health services for eligible individuals for up to three weeks (28 hours a week maximum).
- Non-medical or personal care costs will not be covered under Medicare benefits.
Home health services are a great way to get the care you need in the comfort of your home. Medicare covers an array of home health services under its plan A and B. If you think you or a senior loved one may be eligible for the coverage, consult with your doctor or local provider to see if home health services are the right fit for you.
Please feel free to reach us if you need any assistance in finding home care or home health services. Also, take a look at these related articles for more information:
- Home Health Care: How Does It Differ from Home Care?
- VA Home Health Care Benefits
- Dementia Home Care: Meaning & Importance
- How many hours of home health care does Medicare cover?
Typically, no more than eight hours a day, or 28 hours a week over a period of 21 days. However, in some cases, Medicare may cover home health care for up to 35 hours per week.
- How much does Medicare pay for home health care?
For three weeks, Medicare will pay the home health care cost in full as long as they are deemed medically essential and the beneficiary meets all eligibility criteria. That means there is no fixed amount, and it varies case by case basis.
- Why is home health care important?
Home health care is important for many reasons. It helps reduce health risks associated with hospital stays, allows disabled or homebound individuals to receive quality care, and helps elderly individuals age comfortably and safely in their homes. Additionally, home health care helps keep healthcare costs lower than those associated with hospital stays or residential care facilities. Finally, it reduces stress on family caregivers by providing professional assistance.