Does Medicare Cover Home Health Care? – Overview
If a medical condition prevents you from being mobile then home healthcare services are the perfect solution. Home care providers offer a convenient, inexpensive and efficient way to take care of your needs. Most often, Original Medicare’s Part A and Part B offer to cover the cost of home care services if you are home-bound. Medicare also often pays for certain in-home assistance along with your daily needs for the time it takes you to recover after a severe illness, serious injury or major surgery.
However, if you require coverage for long-term home care, then you need to know the specifics of whether Medicare covers home healthcare.
Does Medicare pay for Home Caregivers?
The kind of homecare you need, the reason you need home care for and the duration for which you require homecare determines whether Medicare will pay for its expenses.
Here’s a look at aspects of homecare that are covered under the Medicare health insurance program:
For In-Home Medical Care
In case you are home-bound due to a serious illness or severe injury, then you are eligible for cost cover under Medicare if you fulfill the following conditions:
- Inability to leave home apart from short time periods, such as for visits to your doctor or to religious services. Additionally, you are eligible for homecare expense cover under Medicare even if you receive in-home treatment at an adult daycare center.
- The doctor has verified that you require homecare and prescribes a plan for the care you need.
- Requirement of skilled nursing care for less than 8 hours a day and less than 28 hours a week, for up to 3 weeks only.
- The doctor expects your condition to improve within a stipulated short time period.
- Requiring skilled physical, occupational and speech therapists to help improve and maintain your existing state of health, or to prevent it from worsening.
- Requirement of home care aide to help you recover completely.
- Need for a home healthcare agency that provides Medicare-approved and certified care.
What kinds of Homecare Services are covered under Medicare?
Medicare covers several kinds of home care services. Some of the services and the Medicare eligibility to receive care are listed below:
If you need a physical therapist to provide you treatment in your home, then Medicare will likely pay for such services:
- Condition assessment
- Exercising and gait training as part of the recovery process after surgery, illness, injury or neurological problems, such as stroke
- Post-surgical wound care
- Wound care for lesions, burns and injuries
In case you need occupational therapy at home, then you can expect Medicare to cover the cost of:
- Establishing daily regimen for medications, caring for personal needs and planning meals
- Training to conserve energy and decrease stress
- Learning to carry out daily tasks safely
- Regaining functional abilities
- Carrying our doctor’s orders
In case you require home care services of a speech therapist, then you can expect Medicare to cover cost of:
- Treatment to recognize and remember words
- Treatment to help you recoverability to swallow
- Therapy to help you eat and drink normally
- Learning about alternatives to communicate in case of speech impediment
- Learning novel communication ways after suffering from loss of hearing
In case a registered or licensed practical nurse needs to visit you at home for treatment, then you can expect Medicare to cover the cost of:
- Changing wound dressings
- Injecting medications
- Changing catheter
- Carrying out tube feedings
- Administering IV medications
- Educating you about taking care of medications and of yourself
In case you require the help of home care aides to visit your home and provide you treatment, then Medicare will cover the expense of:
- Monitoring your vital stats, including heart rate, body temperature and blood pressure
- Ensuring you are taking medications as per doctor’s instructions
- Determining if your home is safe for you, as per your condition and needs
- Checking to ensure that your diet and medications are on par with the doctor’s instructions
In-Home Custodial Care
Medicare normally does not cover the cost of caregivers that help patients with daily activities, unless it is required only for a short period of time, such as when you are recovering from an injury or illness.
In-home custodial care usually included meal preparation and delivery, laundry, shopping, housekeeping and cleaning, bathing, dressing and assistance to use the restroom. Medicare does not pay for a home caregiver to provide these services at your home.
In essence, Medicare does not cover the cost of:
- Round-the-clock care at home
- Full-time skilled nurse services
Medicare pays for home care services that are meant for short time durations, such as for recovering after a severe injury or serious illness. This also includes services like physical therapy, speech therapy, occupational therapy, skilled nurse and social services. Medicare will not cover expenses of extensive in-home care, such as where services like only housekeeping and personal care are required.