Which Home Health services Does Medicare Cover?
* Medicare coverage rules may change anytime. Please call us for the recent up to date coverages.
Medicare covers many different home health care services as long as you are eligible for coverage under Medicare Part A or Medicare Part B. In this guide, the team from At Home Personal Care clarifies the different services and eligibility requirements so that you can make informed choices on the type of care you receive, and that best fits your needs and circumstances. First, let’s discuss what home health care is covered by Medicare Parts A and B:
Medicare Covers Home Care Services under Medicare Parts A and B
Both Medicare Part A and Part B cover a range of home care services, but it’s important to understand the differences of what each plan covers.
For example:
Medicare Part A Covered Home Care Services—Under Part A (sometimes called “hospital insurance”), you can be covered for home care services if you had to spend a minimum of 3 consecutive days at the hospital as an inpatient, or had to have a skilled nursing facility (SNF) stay of the same duration. In this case, you may still require skilled nursing care and therapy at home. Medicare Part A covers the first 100 days of home health care services provided that you meet the eligibility requirements of being essentially homebound and needing skilled care to recover from the injury, illness or condition that precipitated the hospital stay. It’s also important that you start receiving these home care services within a 14-day time frame from your stay at the hospital or SNF.
Medicare Part B Covered Home Care Services—If you require home health services beyond 100 days, Medicare Part B can cover these services.
It’s important to work with your doctor and home healthcare agency to determine your eligibility for Medicare-covered home care services. You’ll need a doctor’s authorization, usually by meeting in-person with the doctor, at the hospital or doctor’s office, within 90 days before beginning home care services, or up to 30 days after starting home care. These days, it’s also possible to include video conference meetings with your doctor as face-to-face meetings. During these meetings, your doctor can determine eligibility based on these factors:
You are essentially homebound; you need a lot of help leaving the house and going places, and it’s very difficult to do.
You require skilled therapeutic care or skilled nursing care on an intermittent basis. In other words, you require this care at least once during any 60-day period, or once a day for three weeks.If you need more care than this, the doctor needs to be able to predict a specific period of time during which you’ll need that care, and when it can safely end.
The care must be performed by a skilled nursing professional or therapist, such as a physical therapist, speech therapist or occupational therapist. It’s best if they are a Medicare-certified provider.
Your doctor should then sign a “home health certification” that designates which specific home health care services you need, why you need them, for how long, and what the desired outcome should be. Your home healthcare agency can then create a plan of care that meets those requirements outlined by your doctor.
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What Specific Home Healthcare Services are Covered by Medicare?
As long as you meet the eligibility requirements, Medicare can cover the following home care services:
1. Skilled Nursing
Medicare doesn't cover long term care Only intermittent visits Skilled nurse 1 hour, 2 or 3 times per week for skilled care for 1 to 9 weeks depending on the skilled need. Nursing care 7 days per week is Medicaid or Long term care.
2. Skilled Therapy
Skilled therapy, provided by a licensed therapist, includes the following modalities:
Physical Therapy to improve physical functioning like gait training and help regaining mobility after an injury or illness.
Speech Therapy can help patients regain speech and language skills that may have been damaged during a stroke or injury.
Occupational therapy helps patients work on regaining the ability to do normal daily life activities independently again, such as eating, dressing, bathing, and more.
3. Home Health Aide
Medicare will only pay for the services of a home health aide if you also require skilled nursing or skilled therapy care. A home health aide can assist with day-to-day activities such as dressing, eating, bathing and toileting.
4. Medical Social Services
A serious illness or traumatic injury that necessitates home healthcare services also impacts your emotional and mental health. Medicare also covers help from a medical social services professional who can help you find helpful community resources and mental health counseling.
5. Medical Supplies
Your Medicare-certified home health agency will usually require medical supplies like needles, catheters and wound dressings to care for your needs. Medicare will cover these supplies also.
6. Durable Medical Equipment
Medicare can pay up to 80% of the cost of DME like walkers or wheelchairs.
If you think you or a loved one may require home healthcare services and want to discuss how Medicare may cover those services, please contact At Home Personal Care today. As a certified Medicare home health care provider serving families throughout Northern Virginia, we can help you receive the benefits that you need.* Medicare coverage rules may change anytime. Please call us for the recent up to date coverages.
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