Home health care encompasses a broad spectrum of medical services delivered right in your home, designed to treat illnesses or injuries. Often, receiving care at home proves to be more affordable, more convenient, and equally effective when compared to receiving similar care in a hospital or skilled nursing facility (SNF).
Medicare, through Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance), offers coverage for eligible home health services. This coverage is available as long as you require part-time or intermittent skilled services and meet the definition of being “homebound.” Being homebound, in Medicare terms, means:
- You find it difficult to leave your home without assistance. This assistance could be in the form of mobility aids like a cane, wheelchair, walker, or crutches, special transportation, or help from another person due to an illness or injury.
- It is medically inadvisable for you to leave your home because of your health condition.
- Leaving your home is typically a significant effort for you.
The home health services covered by Medicare include:
- Medically Necessary Part-Time or Intermittent Skilled Nursing Care: This includes a range of essential services such as:
- Wound care for conditions like pressure sores or surgical wounds, ensuring proper healing and preventing infection.
- Patient and caregiver education, providing crucial knowledge and skills for managing health conditions at home.
- Intravenous (IV) or nutrition therapy, delivering necessary medications or nutrients directly into the bloodstream when oral intake is insufficient or impossible.
- Injections, administering prescribed medications that cannot be taken orally.
- Monitoring serious illness and unstable health status, keeping a close watch on patients with complex medical needs to prevent complications and ensure timely intervention.
- Physical Therapy: Aimed at restoring mobility, function, and reducing pain through exercises and therapeutic techniques.
- Occupational Therapy: Focuses on helping individuals regain the ability to perform daily activities and improve their quality of life by addressing physical, sensory, or cognitive issues.
- Speech-Language Pathology Services: Designed to help individuals with speech, language, communication, and swallowing disorders to improve their communication skills and swallowing function.
- Medical Social Services: Providing support and counseling to patients and their families to cope with the emotional and social challenges related to illness and recovery.
- Part-Time or Intermittent Home Health Aide Care: This service is available only when you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy concurrently. Home health aides assist with personal care tasks such as:
- Help with walking and mobility around the home, reducing the risk of falls and injuries.
- Bathing or grooming, maintaining personal hygiene and comfort.
- Changing bed linens, ensuring a clean and healthy environment.
- Feeding, assisting with meals for those who have difficulty feeding themselves.
- Injectable Osteoporosis Drugs for Women: Covering medications to treat osteoporosis in women at risk of fractures.
- Durable Medical Equipment (DME): Providing necessary medical equipment for use at home, such as wheelchairs, walkers, or hospital beds, to aid in mobility and recovery.
- Medical Supplies for Use at Home: Covering consumable medical supplies needed for treatment at home, like wound dressings or catheters.
- Disposable Negative Pressure Wound Therapy Devices: Advanced wound care devices used to promote healing in complex wounds.
Before you can receive home health services under Medicare, a doctor or a qualified health care provider, such as a nurse practitioner, must conduct a face-to-face assessment to certify your need for these services. Furthermore, a doctor or another authorized health care provider must formally order your care, and the services must be delivered by a Medicare-certified home health agency.
To help you find suitable care, your provider should give you a list of agencies in your area that are certified by Medicare to provide home health services. You can also find this information on the Medicare website using the Care Compare tool. Providers are required to disclose if they have any financial interest in any of the listed agencies, ensuring transparency and helping you make an informed choice.
In most situations, “part-time or intermittent” care is defined as skilled nursing care and home health aide services totaling up to 8 hours per day combined, with a maximum of 28 hours per week. In cases where your provider deems it medically necessary, you might be able to receive more frequent care for a short duration, up to but not exceeding 8 hours each day and 35 hours per week.
It’s important to understand what Medicare does not cover under home health benefits:
- 24-hour-a-day care at your home: Medicare does not cover continuous, around-the-clock care at home.
- Home meal delivery: The cost of meal delivery services is not covered by Medicare home health benefits.
- Homemaker services unrelated to your care plan: Services like general shopping and cleaning that are not directly tied to your medical care plan are not covered.
- Custodial or personal care when it’s the only care you need: If you only require assistance with daily living activities such as bathing, dressing, or using the bathroom, and do not need skilled medical care, Medicare home health benefits will not cover these services.
Eligibility for Medicare home health benefits is contingent on needing no more than part-time or “intermittent” skilled care. You are permitted to leave home for medical appointments or short, infrequent outings for non-medical reasons, such as attending religious services, without jeopardizing your home health care. Participation in adult day care programs also does not disqualify you from receiving home health care benefits.
Medicare programs for in-home care offer valuable support for those recovering at home or managing chronic conditions. Understanding the scope of these benefits and eligibility requirements is crucial for accessing the care you need.
