Medicare and Home Health Care Coverage

Medicare provides coverage when you’re in the hospital or a skilled nursing facility, but what about when you need health care services while you are at home? There are many instances where Medicare beneficiaries don’t require hospital admittance or were just discharged, but need temporary medical care at home while recovering from an injury or illness. Let’s explore what home health care is, what part of Medicare covers these services and the necessary qualifications to receive these benefits.

What Is Home Health Care?

Medicare beneficiaries who require assistance in their home to heal from an injury or illness and regain their health and self-sufficiency may need home health care support. These services, provided by Medicare-certified home health agencies, include assistance and care to fulfill a wide variety of needs. The scope of services provided by Medicare will be skilled in nature, not custodial. Skilled services include checking vitals, treating wounds, ministering comfort, monitoring pain levels, performing injections, helping ensure adequate nutrition and proper prescription drug intake, coordinating care with doctors and more. At times, home health care services may include physical therapy, occupational therapy and speech-language pathology services. Home health care staff also help the patient self-manage care while educating caregivers.

It’s important to note that home health care does not cover the following services:

  • 24-hour home health care
  • Meal delivery
  • Custodial care/activities of daily living (if this is the sole service being provided)
  • Housekeeping/cleaning services

What Part of Medicare Covers Home Health Care?

Medicare Part A (Hospital Insurance) – covers inpatient care in hospitals, hospice care, skilled nursing facility (SNF) care and home health care (usually after discharge from a hospital or SNF). Medicare Part B (Medical Insurance) covers outpatient care, preventative services, long-lasting medical equipment and some medical services including certain types of occupational therapy, physical therapy, mental healthcare and home health care services. In summary, both sections of Medicare provide home health care coverage.

When Does Medicare Cover Home Health Care?

Medicare offers home health coverage under certain circumstances: when a doctor orders these services and refers you to a home health agency. The doctor creates a plan of care that home health staff follow, then reviews and updates it regularly.

A Medicare-approved provider must certify that the patient in question is homebound. Homebound means you need another person’s help or the assistance of medical equipment such as crutches or a wheelchair to leave the house. In other situations, a doctor must instead certify that you need sporadic skilled nursing care and/or physical therapy, occupational therapy or speech-language pathology services. These are the circumstances in which Medicare will cover home health care.

How to Receive Home Health Services

When your doctor or provider determines that you require home health care, you are free to choose from the Medicare-certified home health agencies in your area. (Keep in mind if you receive your Medicare benefits through a Medicare Advantage plan, you may need to select an agency within your plan network). Consult with Medicare or your plan provider for a list of agencies in your area. You may want to select an agency that has experience providing the type of care you need, so reference your plan of care. Your plan of care as prescribed by the doctor describes the services required, the health professionals needed to administer the care, frequency of the services, necessary medical equipment, expected outcomes and other details.

Recovering and regaining your good health is possible thanks to home health care coverage and expert medical caregiver assistance. Get started on the path to recovery and take advantage of your Medicare benefits that cover home health services. Should you need help with understanding your Medicare plan benefits or evaluating coverage options, our licensed insurance agents at Medicare Portal can assist with no cost to you. Contact us today for lifetime Medicare assistance.

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