Does Medicare Cover Home Health Care?

Great news: Medicare covers at-home healthcare services. The thing is, there are a few complexities to understanding the extent of Medicare’s coverage of in-house healthcare services, and that’s what we’re going to discuss today: What home health care is covered by medicare?

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What Type of Home Care Does Medicare Cover?

The term “at-home healthcare” may sound rather broad, and may mean many different things to different people. When it comes to Medicare coverage, at home healthcare refers to:

Home-Based Skilled Nursing Care: A nurse who visits your home to check your vitals and tend to your wounds, is an example of the type of at – home care that Medicare can cover. Any type of skilled nursing care such as tube dressings or medication injections that occur in your house will be covered under Medicare.
Home Health Aides: If you are receiving skilled nursing care as well, then Medicare will cover the expense of home health aides who can help with daily activities such as dressing or bathing.
Intermittent Therapy: Temporary occupational, physical, and speech therapy received at home are covered under Medicare. For example, if you were in an accident and require at-home physical therapy to improve your mobility, that is covered.
Medical Social Services: You may need counselling to help with social and emotional concerns with regards to your illness, in which case, Medicare can cover the necessary social services. This, for example, might mean that someone helps you join a local group for people with similar ailments.
Medical Supplies: Medicare also helps cover the cost of medical supplies. Supplies like dressings for your wounds or incontinence will be covered. Medicare will typically pitch in 20% of the cost of larger items like wheelchairs or walkers.

Just as it is crucial to understand what home healthcare is, it is also important to understand what it is not:

Around-The-Clock-Care: Your at home care should not exceed 28 hours a week. At-home care is not the same as long term care, nor is it a substitute for nursing homes.
Non-Medical At Home Services: While Medicare may cover cleaning or meal services if part of your doctor’s treatment plan, such services on their own are not covered by Medicare.

When Do I Qualify For Home Health Care Coverage?

Now that you understand what home health care looks like, there are five basic requirements that you need to meet in order for Medicare to cover your home health care:

You Are Homebound. This means that you are not able to leave your house without exerting considerable effort, or without the aid of either another person or a device such as a walker.
A Medical Professional Has Ordered the Care. A professional such as a doctor or nurse practitioner must certify that you require at-home care in order for Medicare to cover the cost of it.
Your Certification for Care Falls Within a 120 Day Period. You must receive certification from a medical professional that you need the care between 90 days before and 30 days after the care begins. Additionally, if your care exceeds 60 days, your medical professional must renew the certification for another 60 days or coverage will cease.
The At Home Care is Issued By a Detailed Plan. The medical professional certifying your need for care, must also draw up a plan for which services and supplies you’ll receive, who will issue the care, and their expectations for the outcome of such care. Medicare’s coverage will only extend to the services within that plan.
Health Agencies Are Approved By Medicare. There are over 11,000 agencies across the country that have the Medicare stamp of approval to provide your home healthcare services. Plans A and B allow you to choose from any one of these healthcare agencies, but some Advantage plans have a smaller pool to choose from.

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What If I Want More Coverage?

Though Medicare coverage is quite extensive, you may wish to have more coverage. In such cases, Medigap plans allow you to purchase additional coverage to add to what is already under Medicare.

Why In-Home Care?

The phrase “home sweet home” exists for good reason. Unlike a cold, impersonal hospital, your home is your safe space. And in the event of illness or injury you deserve the ability to receive healthcare in the comfort of your own home.

Margaret Huntley Margaret Huntley is a creative writing and philosophy student at Western University. She has been working as a freelance writer for over two years and has written about everything from insurance, to poker, to health and wellness for international businesses.