An Ultimate Guide on Medicare Coverage for Home Health Care

What is Medicare?

Medicare is the federal health insurance program. It is age or diagnose-based and intended for people aged 65 or older, younger people with disabilities, and people with permanent end-stage renal disease (permanent kidney failure that requires dialysis or a transplant), or Lou Gehrig’s disease (ALS). You can receive Medicare benefits under four different parts: A, B, C, and D.

What is Home Health Care?

Home health care involves a wide range of medical care that you receive in your home for illness or injury. Skilled home health care is intended to treat disease or injury and help you live independently for as long as possible.

Which Home Health Care is Covered by Medicare?

Medicare may cover eligible skilled home health services, including intermittent nursing and therapy. Home health aides do not replace licensed nurses. Part-time or intermittent aide care is covered only when the beneficiary also receives qualifying skilled services.

Depending on your eligibility, you can receive Medicare home health care coverage under Part A (hospital insurance) or Part B (medical insurance). Medicare pays the full cost of home health care under both plans. Home health care is normally covered by Part B. Under Part B, you need to be homebound and need skilled care to qualify for home health care. Under Medicare Part B, there is no prior hospitalization requirement.

Ask Medicare or your plan which benefit applies to your circumstances. A prior hospital stay is not required for every home health benefit.

Eligibility requires a provider-ordered plan, qualifying skilled services, homebound status, and a Medicare-certified home health agency. Homebound does not mean a person can never leave home.

How Much Does Medicare Pay for Home Health Care?

Eligible beneficiaries pay nothing for covered home health services. After the Part B deductible, they generally pay 20% of the Medicare-approved amount for covered durable medical equipment. Ask the agency about any uncovered services before care begins.

However, Medicare won’t cover for home aides that help with household services (housework, cooking, shopping, laundry) and personal care (bathing and dressing). Also, Medicare doesn’t cover long-term care for conditions like Alzheimer’s or cancer.

Can Medicare Pay for a Caregiver?

Medicare home health coverage may continue while eligibility requirements are met. It does not pay for personal or custodial care when that is the only care needed.

Also, the home health agency whose services you are receiving needs to be Medicare certified.

Kansas families can ask KanCare and KDADS about self-directed services and who may be paid as an attendant. These Medicaid rules are separate from Medicare, and payment to relatives requires program approval.

Who Qualifies for Home Health Care Services?

To qualify for home health care, you have to meet certain criteria. Firstly, you need to be considered homebound, which means that you cannot leave your home without help because of illness or injury, or it is not recommended for you to leave home because of your condition. Your doctor needs to certify that you are homebound and require at least one of the following services:

• Intermittent skilled nursing care
• Physical therapy
• Ongoing occupational therapy
• Speech-language pathology services

Finally, home health care needs to be provided from a Medicare-approved home health agency.

What Does Home Health Care Include?

Many people require medical assistance after the age of 65. Home health care includes medical care services in your home that you receive for illness or injury. Home health care includes services such as intermittent skilled nursing, occupational therapy, physical therapy, and speech therapy. Home health care is typically carried out by licensed therapists, nurses, or home health aides who work for hospitals, home health agencies, or public health departments licensed by the state.

Does Social Security Pay for Home Health Care?

It depends upon the circumstances of your disability, as every person’s case is different. Social Security is the foundation of economic assistance for disabled persons, retirees, and families of disabled, retired, or deceased workers. About 61 million Americans collect Social Security monthly benefits. If you are disabled and approved for Social Security Disability Insurance (SSDI), you will receive Medicare insurance. Medicare will help pay for home health care as long as you are considered homebound and receive skilled care. You also have to attain the doctor’s approval that you qualify for Medicare under the aforementioned circumstances.

Is Visiting Angels Covered by Medicare?

Medicare coverage depends on the service and eligibility rules, not an agency’s brand name. Non-medical companionship and custodial care alone are not covered by the Medicare home health benefit. Confirm any specific agency and service directly with Medicare and the provider.

How Much Does Private Home Care Cost?

The cost of private home care depends on several factors, in the first place, on the number of hours the designated care worker spends with you. It also depends on the kind of services and the supplies needed to assist you with your condition.

Private home care costs vary by location, schedule, and services. Request a current written estimate for the non-medical care you need in Wichita.

Sources: Medicare home health coverage and long-term care coverage. Devoted Helpers provides non-medical home care, companionship, and everyday assistance. We do not provide skilled home health services.