Does Medicare Cover Home Care Services?

When it comes to affording in-home care for seniors, Medicare can turn out to be a major resource, but not for all services. Understanding what benefits are available and their requirements and limitations can help in the planning of care for oneself or a loved one. Below, we discuss Medicare home health coverage in detail, including eligibility requirements and what assistance it offers.

1. Basic Definition of Home Care Services

Home care means services of health and supportive nature provided in the comfort of a person's home. Services could include skilled nursing, physical therapy, assistance with daily activities, and medical social services. With respect to home care, these skilled services are catered for generally through Medicare, though others, such as the non-skilled or long-term custodial care, generally may not be included under some Medicare plans.

2. What Medicare Basically Covers

And just like Medicare Part A and a certain set of in-home services under Part B could be covered by Medicare, such in-home services would have to fit one of these definitions:

• Skilled nursing care: Part-time or intermittent nursing care from a registered nurse or licensed practical nurse under the order of a physician.
• Therapy: Physical therapy, occupational therapy, or speech therapy, particularly if those therapies are needed to treat or manage a condition.
• Home health aide services: Help with personal care like bathing or dressing, if part of a more extensive, doctor-ordered home health program.

3. Requirements for Eligibility

To be eligible for home health services under Medicare, individuals must meet the following requirements:

1. Physician's Order: That's an order from a doctor certifying the need for intermittent skilled care and delineating the plan of care.
2. Homebound Status: You are considered "homebound" when you make a significant effort to leave home or are medically unable to do so without getting assistance.
3. Medicare-Certified Agency: Care must be provided through a Medicare-certified agency.

4. Service Frequency and Duration

Home health care under Medicare is usually of an intermittent and short-term nature. If long-term or continuous custodial care is indicated, such as assistance with cooking, cleaning, and personal care not strictly skill-based services, coverage under Medicare may not be applicable.

5. General Costs and Out-of-Pocket Expenses

• Part A and Part B Deductibles: Depending on the type of service and how long it takes, deductibles and coinsurance may apply.
• Part B Premiums: You will continue to have to pay your monthly Part B premium.
• Additional Services: Any durable medical equipment needed (like wheelchairs or walkers) may have its own cost-sharing rules.

6. What Medicare Will Not Cover

What Medicare generally does not cover are:

• 24-hour home care
• Meal delivery
• Full-time custodial or personal care services if that's the only type of assistance needed
• Homemaker service for grocery shopping, cleaning, laundry, etc. (unless included with skilled care)

7. Alternative Coverage Options

• Medicare Advantage Plans: Some Medicare Advantage (Part C) plans may offer expanded home care benefits not covered by Original Medicare.
• Medicaid: If you meet a certain income and asset threshold, Medicaid could provide long-term home care services that are not available through Medicare.
• Private Insurance: Long-term care insurance policies typically fill these gaps but have varying premiums and eligibility criteria.

8. How to Get Started

If you suspect that you or a loved one qualifies for home health care through Medicare:

1. Consult Your Physician: Talk about health demands and obtain an assessment for criteria about skilled service necessity.
2. Select a Certified Agency: Ensure your home health provider is Medicare-certified.
3. Review Your Plan: Confirm eligibility, coverage details, and any costs or copays, if applicable.

Understanding your Medicare benefits assures you and your loved ones that when coverage supports skilled needs, at-home services can make a significant difference in safety, recovery, and independence-right at home.