What Home Health Care Services Are Covered By Medicare?

As the population ages, many individuals and their families are exploring options to ensure their health and well-being while remaining in the comfort of their homes. One of the primary resources for funding these services is Medicare, the federal health insurance program for people aged 65 and older, as well as for some younger individuals with disabilities. However, navigating what is covered can be complex. This blog will help you understand what home health care services are covered by Medicare.

What Is Home Health Care?

Home health care encompasses a wide range of health and supportive services provided in a person’s home. These services can be a great alternative for individuals who need medical care or assistance with daily activities but prefer to stay in their homes rather than moving to a facility. Home health care services include skilled nursing care, physical therapy, occupational therapy, speech therapy, and assistance with daily living activities.

Medicare Coverage for Home Health Care

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health care services. To qualify for coverage, the following conditions must be met:

1. Doctor’s Orders: A doctor must order and certify that you need one or more of the following:
   • Intermittent skilled nursing care (not continuous care)
   • Physical therapy
   • Speech-language pathology services
   • Continued occupational therapy
2. Homebound Status: You must be homebound, meaning that leaving home requires a considerable and taxing effort and that you are unable to do so without assistance.
3. Medicare-Certified Agency: The home health agency providing care must be Medicare-certified.

Services Covered by Medicare

If you meet the eligibility criteria, Medicare covers the following home health care services:

1. Skilled Nursing Care: Medicare covers part-time or intermittent skilled nursing care provided by a registered nurse (RN) or a licensed practical nurse (LPN). This care includes medical services such as wound care, intravenous (IV) therapy, injections, and monitoring of a patient’s condition.
2. Therapy Services:
   • Physical Therapy: To help regain movement and strength following an injury or illness.
   • Occupational Therapy: To assist with regaining the ability to perform daily activities independently.
   • Speech-Language Pathology: For recovery of communication skills and swallowing issues.
3. Medical Social Services: These services are provided by a social worker to help with social and emotional concerns related to your illness. This can include counseling or help finding community resources.
4. Home Health Aide Services: Medicare covers part-time or intermittent home health aide services for personal care such as bathing, dressing, and using the bathroom. These services must be part of the care plan, but Medicare does not cover 24-hour-a-day care at home.
5. Medical Supplies and Equipment: Medicare covers medical supplies, like wound dressings, and durable medical equipment (DME) such as wheelchairs, hospital beds, and oxygen equipment that you need while receiving home health care.

What Medicare Doesn’t Cover

It is also essential to know what Medicare does not cover. These include:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services like shopping, cleaning, and laundry
• Personal care services (like bathing, dressing, or using the bathroom) if this is the only care you need

How to Get Started with Medicare Home Health Care

If you believe you or a loved one may be eligible for Medicare-covered home health care services, follow these steps:

1. Consult Your Doctor: Speak with your healthcare provider about your needs and discuss whether you qualify for home health care services under Medicare.
2. Develop a Care Plan: If eligible, your doctor will help develop a plan of care and determine the frequency and type of services you require.
3. Choose a Medicare-Certified Home Health Agency: Ensure the agency you select is certified by Medicare to ensure coverage.

Conclusion

Understanding what home health care services are covered by Medicare can help you or your loved ones receive the necessary care while staying in the comfort of home. By meeting eligibility requirements and working with your healthcare provider, you can take advantage of these covered services to improve your health and quality of life.

If you have any questions about Medicare coverage or need assistance finding a Medicare-certified home health agency, feel free to contact us at Good Sisters & Brothers Home Care Services LLC. We are here to help you navigate your healthcare options and provide the support you need.