As you age, you may require assistance completing everyday tasks like walking, bathing, dressing, and preparing meals. You also may strongly feel that you want to remain in your home and not move into an assisted living facility or nursing home. This is when Home Health Care Services becomes essential, and it’s important to know what you’re entitled to before you need it.
Which Home Health Care Services Are Covered by Medicare?
Many home health care services are covered by Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). Typically, a home health care agency coordinates the services your doctor orders for you.
Eligible home health care services include:
- Part-time or “intermittent” skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide services (personal hands-on care)
- Injectable osteoporosis drugs for women
Medicare does not pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services like shopping, cleaning, and laundry (when this is the only care you need)
- Custodial or personal care like bathing, dressing, or using the bathroom (when this is the only care you need)
Who’s eligible for Home Health Care Services?
To be covered, you must meet specific eligibility requirements.
- You must be under the care of a doctor who certifies that you need one of the covered services.
- Your doctor must create a Plan of Care and review it regularly to gauge your progress.
- Your condition must meet specific criteria. You are eligible for Medicare coverage in any of the following situations:
- Your condition is expected to improve in a reasonable and generally predictable period of time.
- You need a skilled therapist to safely and effectively create a maintenance program for your condition.
- You need a skilled therapist to safely and effectively provide maintenance therapy for your condition.
- A doctor must certify that you’re homebound.
- The home health agency caring for you must be Medicare-certified.
How to Find a Home Health Care Provider
Finding a home health care provider can feel overwhelming. Medicare’s website (medicare.gov) offers a Home Health Compare feature to help you learn more about the home health care providers in your area. You can access Home Compare here or follow these steps:
- Visit medicare.gov
- Type “home health compare” into the search bar
- Click on the first link that reads “Medicare Home Health Compare”
- Enter your zip code in the “My Location” field
Each result specifies the services provided by that agency and provides two ratings – a “quality rating” compiled by Medicare and a “patient survey rating” collected from actual patients. You may choose up to three providers at a time to see a side-by-side comparison of their ratings and services.
Be an Advocate
There are occasions where a patient is incorrectly denied coverage. If this happens, visit the Center for Medicare Advocacy (CMA) at www.medicareadvocacy.org. The CMA produces informative materials on Medicare-related topics that will make you more knowledgeable and thus better able to advocate for yourself or a loved one. If necessary, you may call the CMA and ask for their advice regarding your case.
Much about Medicare is not black and white. Trying to learn what benefits you’re entitled to when you’re in the thick of needing it can be overwhelming. That’s why we recommend planning whenever possible. Learn what benefits you and your loved ones are entitled to before you need it. It will make the implementation process a little smoother down the line.