Does Medicare Cover Home Care, and How Can I Qualify?

If you have a medical condition that renders you homebound, you may be eligible for Medicare home health care. It adds convenience and low cost for those who qualify, and helps those who need it the most get the quality care they deserve.

home health care provider helping elderly patient at her home

Does Medicare Cover Home Health Care? 

At times and for certain conditions, Medicare coverage parts A & B may cover your short-term medical care if you’re home bound. This includes short-term coverage for your daily needs while recovering from accident, surgery, or illness.

Who’s Covered?

To receive Medicare home care benefits, the following requirements must be met:

  • You’re unable to leave your home without considerable effort, or you’re entirely home bound. This includes if requiring the assistance of another for mobility, or needing a wheelchair, walker, or other mobility device to get around.
  • Your doctor or certified medical professional has certified your need for home therapy, including nursing care, occupational therapy, and speech therapies as needed on an intermittent basis.
  • Certification must be face-to-face, and be no more than 90-days before, or 30-days after the start of your home treatments.
  • You also need to be under planned care that’s established and reviewed regularly by your doctor. Along with what results your doctor expects, the plan needs to include the services you need, how often you need them, who will supply them, and what supplies are needed.
  • Medicare has approved of your need for compassionate, in-home care.

What’s Covered? 

Both Medicare part A (hospital insurance) and part B (caretaker coverage) may provide home care coverage that includes:

  • Skilled Nursing Care You may need the assistance of a licensed practical nurse or registered nurse in your home to change catheters, change wound dressings, monitor IV drugs, or to carry out tube feedings. A nurse may also help with teaching you how to monitor your medications and other means of developing your independence.
  • Home Health Aids Personal activities such as using the restroom, bathing, or dressing may require the assistance of a home health aid. However, this is a service Medicare will only cover if you are receiving skilled nursing care or therapy.
  • Physical Therapy Recovery from surgery, injury, stroke, or other maladies may require a therapist to visit your home. This includes speech and other therapies to help you regain abilities lost due to accident, illness, or medical procedure.
  • Medical Supplies Medicare may also cover in-home medical supplies such as wound dressings, catheters, or other supplies to cover your needs. However, Medicare only covers around 80% of the cost for durable supplies such as walkers, crutches, or wheelchairs .
  • Medical Social Services Those receiving skilled nursing may receive counciling to help with social concerns due to an illness or accident, and Medicare can also help locate community resources for you.

What’s Not Covered?

Though Medicare covers many in-home medical needs, they DON’T cover:

  • 24-hour-per-day home care
  • Personal or custodial care without the presence of other types of care
  • Household services unrelated to your care plan
  • Home meal delivery

Finding Caregivers

To find and compare certified home caregivers in your area, you can go to Medicare’s website for a search and compare tool. While those with the original Medicare plans part A & B can choose any approved caregiver agency, those with Medicare Advantage from a private insurer may need to use an agency their plan works with.

Prior to receiving home health care, your provider should let you know how much of the cost Medicare will cover, along with your cost for items or services that aren’t covered. This will be broken down for you in an Advanced Beneficiary Notice, or ABN, that’s given to you by your provider before any services or supplies are rendered.

For Original Medicare, your costs are:

  • 0% for home health services
  • 20% of the amount approved by Medicare for durable items such as walkers, beds, or wheelchairs

Questions to Ask Your Provider 

When choosing your provider, be sure to ask them questions about Medicare home health care that include:

  1. Are they Medicare certified, and where applicable, Medicaid certified?
  2. Do they offer the services you need, such as skilled nursing and personal care?
  3. Will they help arrange services for you that are NOT offered by Medicare, such as meal delivery or long-term care?
  4. Are their hours and location convenient to your needs?
  5. Is their staff available at odd hours such as nights or weekends in the event of an emergency?
  6. Will they explain ALL coverages, including what’s covered by Medicare and your out-of-pocket expenses?

You should also ask for testimonials from past patients, doctors, or family members that verify the home health service’s level of quality, as well as ensure the provider meets your language, cultural, and personable needs.

Why Intermountain Health?

Seeking a qualified healthcare provider means ensuring all your needs are met, which includes having access to Medicare home health care. At Intermountain Health, we bring you that and more in our quest to go above and beyond your premium healthcare needs.

With our many state-of-the-art facilities conveniently located throughout the state, you can rest assured there’s one near you with its staff of highly-trained medical professionals there to put your needs first.

Need to get back on your feet as quickly as possible with compassionate, affordable Medicare home health care?

At Intermountain Health, we’re always here for you!

*This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician or qualified healthcare professional.

Part of being well is being heard.