Does Medicare Cover Home Health Care? How Else Can I Pay?
Does Medicare Cover Home Health Care?
The short answer is yes. But as with all matters dealing with Medicare, there is quite a bit of complexity in the issue. When looking at home health care options for yourself or an ill loved one, it’s not uncommon to feel bewildered. A person can browse Google results for “does Medicare cover home health care” for ages and come away still feeling confused, and this, on top of coping with sickness in herself or her loved one. So, this post seeks to briefly explain what Medicare does and does not cover for those seeking home health care. Fortunately, if home care with Medicare is not an option, there are other kinds of coverage that can help people in need.
Receiving Medicare Benefits for Home Care
To qualify for Medicare’s home care benefits, a patient must meet certain strict conditions.
She must have a doctor who curates and reviews her care regularly.
She must meet the doctor or one of his associates face-to-face within three months before beginning home care.
She must be home bound, unable to leave the home without assistance. Leaving the home for medical treatment is acceptable, as are short, infrequent departures for nonmedical reasons.
She must need the attention of skilled practitioners such as nurses and therapists. This treatment must be occasional and not full-time.
Someone who fails to meet these conditions might still be able to receive care and coverage at a medical facility, or she might be able to receive benefits from other sources or pay out of pocket for services.
What Will Medicare Cover in Home Care?
Medicare Part A and Part B both cover many home health services. If you qualify for the home benefit, you will have to pay $0 for those home services. This includes.
Intermittent skilled nursing
Physical, occupational, and speech therapies that will improve the patient’s condition
Social services such as counseling
Home health aide assistance, when provided alongside skilled services like nursing
Single-use medical supplies
Additionally, coverage is not complete for certain kinds of durable medical equipment, such as wheelchairs and oxygen respirators. For equipment, Part B will cover 80% of the costs; the rest will have to be paid out of pocket or covered by other insurance options, and the Part B deductible may also apply.
What Does Medicare Not Cover?
Not all services that conceivably fall under “home care” are covered by Medicare. These are sometimes covered by other insurance options, or the patient can perhaps receive covered care at a nursing home or hospital.
It will not cover around-the-clock home care. If the patient requires 24/7 care, she will need to search for other options than home care.
It will not cover costs incurred beyond the “intermittent” services as described above. Some agencies will provide services beyond what is mandated by Medicare, but these additional services will have to be covered by supplemental coverage or out-of-pocket.
Long-term care is not covered. A patient who is still unwell after the twenty-one-day limit may have to transfer to a facility or look for other coverage options.
Home health aide services are covered only if the patient is also receiving skilled help.
Any home services, like laundry and cooking, that are unrelated to the patient’s care plan.
Anyone looking into home health care should consider the possibility of paying for these additional costs as well. It can be a little confusing to sort out what is and isn’t covered by Medicare. Every home health agency must present a list of the charges detailing any costs, including what is covered by Medicare and other insurance, and what you will have to pay out of pocket. They must also give notice before giving you any services that are not covered.
How Long Does Home Coverage Last?
To qualify for the home Medicare benefit, the patient must need only part-time or “intermittent” assistance from skilled nurses or therapists. “Intermittent,” in this case, means less than eight hours a day, fewer than seven days a week, for a maximum of twenty-one days. This includes the assistance of a home health aide, whose services are covered as long as the patient also receives skilled medical help.If the patient needs help for all seven days of the week or for more than eight hours a day, then she is not eligible for home health care coverage and will have to utilize other insurance, pay out of pocket, or take up residence in a care facility.Does Medicare cover home health care beyond these limits? Only the twenty-one-day maximum is not set in stone. If the doctor estimates that the patient will no longer need care at a certain time, then an extension may be granted, allowing the patient to continue receiving home care coverage.
In addition to Parts A and Part B, there are other ways to cover in home health care. For those who have it, Medicare Advantage offers some coverage that is not available on Parts A and B; for example, some Advantage plans offer meal deliveries.Medigap is an alternative to advantage that is meant to fill in some spaces in coverage left by Medicare. Medigap can cover the 20% out-of-pocket expense for durable medical equipment that is left to the patient under Medicare.Some private insurance plans offer benefits for home care. Most are similar to the Medicare benefits described above, but some even cover modifications to the patient’s home. In general, those who can combine Medicare with private insurance will likely have a little more of their costs covered, but every insurance plan is different, so you will have to get in touch with your provider to find out what they might cover.People with limited means (those with an income of 133% or less of the federal poverty line) or certain disabilities can benefit from Medicaid. Each state issues Medicaid differently; California’s form of Medicaid is Medical, and it offers similar benefits to Medicare.Veterans who live with a disability caused by their service can receive home health care coverage from the Veterans Administration.Most of these options, including Medicare, are meant to be used by those recovering from illness or injury. That is to say, they help those who are ailing for only a short time. But those who purchase long-term care insurance can receive home care for far longer than what is covered by Medicare and other plans.