Generally, Medicare does not cover in-home healthcare for personal care or housekeeping if that is all the care you require. Medicare may provide home healthcare coverage in the following cases if you:
- Require medical care to recover from surgery, an illness, or an injury; Medicare may cover the cost of short-term caregivers.
- Are homebound, and your doctor orders it, Medicare will cover short-term home health services such as physical therapy, skilled nursing care, or occupational therapy.
- Are suffering from a medical issue that makes it difficult for you to go out, home healthcare may be a more convenient, affordable, and effective way to receive the care you require.
Original Medicare (Part A & Part B) may occasionally cover home healthcare if you are homebound. Additionally, Medicare may cover some in-home assistance with daily activities following an illness or injury.
However, if you require long-term assistance with daily activities in your home, it’s critical to understand that Medicare does not typically cover those caregiving services.
Does Medicare provide coverage for home health care?
Medicare coverage for in-home caregivers is conditional on the type of care received, the reason of need and the duration.
Medical care provided in the home
If you are staying at home due to an illness or injury, you may qualify for Medicare home health benefits if each of the following conditions applies:
- You are not permitted to leave the house except for brief outings such as doctor visits or religious services. One exception: If you attend adult daycare, you may continue to receive in-home care.
- Your physician verifies that you require in-home care and develops a plan outlining the services you need.
- You require specialized nursing care (less than 8 hours per day and no more than 28 hours per week for three weeks).
- Your doctor believes that your condition will improve in a reasonable, or at the very least, predictable, time.
- You require the services of a skilled physical, occupational, or speech therapist to develop a program to assist you in improving, maintaining your current state of health, or preventing deterioration.
- You require a home health aide to assist you in your recovery.
- The home healthcare agency that is providing your care is approved or certified by Medicare.
- To maintain eligibility for in-home care, you must see your doctor no more than 90 days before or 30 days after beginning home healthcare services.
For what types of services am I eligible to get home healthcare?
Medicare covers a wide variety of services, some of which you can avail in the comfort of your own home. The following are some services and the applicable Medicare rules.
If you receive physical therapy in your home, Medicare is likely to cover the following services:
- Evaluation of your condition
- Gait training and exercises to help with recovery after surgery, an injury, illness, or a neurological condition like stroke.
- Care of postoperative wounds
- Wound care for burns, abrasions, and lesions
Counseling occupational therapy
If an occupational therapist treats you in your home, you can anticipate the following services:
- Assistance with establishing daily routines for medication administration, meal planning, and personal care
- Instruction in energy conservation and stress reduction techniques
- Instructing you on how to perform everyday tasks safely
- Assisting you in regaining the ability to function following your needs and circumstances.
- Assisting you in carrying out your physician’s orders
Therapy of the tongue
If you work with a speech therapist in your home, you may get the following services:
- Assistance with recalling or recognizing words
- Therapy to rehabilitate your swallowing ability
- Therapy to assist you in eating and drinking as normally as possible.
- Education about alternate modes of communication if you are unable to communicate verbally.
- Instruction on alternative ways of communication if you have lost your hearing
Providing nursing care
If a registered nurse or licensed practical nurse visits you in your home to provide care, the following may occur:
- Change the dressings on your wounds.
- Replace your catheter
- Provide medications via injection
- Administer tube feedings
- Give intravenous medications
- Educate you on proper medication administration and self-care.
On the other hand, home health aides are more likely to assist you with the following services:
- Keep checking your blood pressure, heart rate, and body temperature.
- Ensuring that you are taking your medications properly
- Determining the safety of your home in light of your needs and conditions.
- Ensuring that your eating and drinking habits are healthy
Additionally, you may qualify for in-home social services. If you are eligible, you may receive assistance in locating resources in your community that will assist you in adjusting to your condition. Additionally, you may receive counseling for your need at a social, emotional, or psychological level.
The cost of home healthcare service
According to a 2019 industry survey, the average monthly cost of a home health aide is likely to be $4,385 per month. The same study states that the average monthly expense of providing custodial care services is $4,290.
Which components of Medicare provide home health care?
Medicare Part A covers hospitalization. If you are in hospital for three consecutive days or if Medicare covers your stay in a nursing facility, Part A will cover 100 days of home healthcare as long as you receive home healthcare services within 14 days of leaving the hospital or nursing facility.
Part B of Medicare provides medical coverage. If you require home health care but have not been admitted to the hospital first, Part B will cover your costs. However, it would be best to meet all other eligibility criteria to get coverage.
Part C (Medicare Advantage)
These plans offer the same essential benefits as the Original Medicare, but private insurers administer them.
Medicare Part C (Medicare Advantage) plans may require you to receive home healthcare services from a provider network agency. Consult your plan for specifics.
Medicare Part D plans are also considered as private insurance. They cover a portion or all of the cost of any prescription medications you may require during your period of home healthcare.
Medicare Suplement (Medigap)
Medigap policies, like Part C and Part D plans, are sold by private insurance companies. They may assist you in covering the costs of home healthcare that Medicare does not cover.
Medicare does not provide coverage of an in-home caregiver if you only require custodial care services such as housekeeping and personal care. It may cover some short-term custodial care if your doctor certifies that you are homebound.
Medicare does cover home health services such as physical therapy, occupational therapy, speech therapy, skilled nursing care, and social services if you are homebound due to surgery, illness, or injury.
Your physician must certify that the services are medically necessary, and Medicare must approve the home health agency.