Does Medicare Pay for Home Health Care?

Home health care is an alternative to traditional in-hospital care that’s growing in popularity. Care at home offers convenience, ease of access and peace of mind for many families in the US. However, like all other health care options, cost is often a consideration. Not all families can afford to pay in full for home health care services out of pocket. Seeing as in-hospital treatments are normally covered by Part A of a Medicare plan, you might think that you have to opt for hospital care to qualify for cover. But does Medicare pay for home health care under some circumstances? The good news that there are home health care services you can access through your Medicare plan.

What Does Medicare Cover for Home Health Care?

Medicare is a government health plan funded through tax money. Most people contribute to Medicare during their working years. In the same way you contribute to social security tax, part of your income tax goes towards Medicare cover. Cover provided by Medicare can is divided into four categories; Part A, Part B, Part C and Part D.

Most Americans are only eligible to claim Medicare benefits are the age of 65, or after retirement. However, there are exceptions. Certain people with severe disabilities can be eligible for Medicare benefits even before retirement age.

What Does Part A and B of A Medicare Plan Cover?

Upon retirement, American tax payers normally qualify for Part A Medicare cover automatically without the need to pay monthly premiums. Part A covers hospital care or the cost of being in a medical facility.

Although this cover is useful, it’s not a comprehensive health care plan that will pay for all your health care expenses. Additional costs such as visits to the doctor, medical tests, medical equipment and certain procedures are covered by Part B of a Medicare plan. Unlike Part A, there is a monthly premium of approximately $144 for Part B Medicare cover.

What Does Medicare Pay for Home Health Care?

Provided you have both Part A and B cover, you can claim for from Medicare for any of the following home health care services:

  • Part-time or intermittent nursing services
  • Part-time or intermittent home health aides
  • Physical therapy
  • Occupational therapy
  • Medical social work

Considering all the home health care services covered by Medicare, you can claim for almost any home health care service available. The only drawback is that you can’t claim for home health care benefits indefinitely. There are some requirements candidates must fulfill in order to claim home health care from Medicare.

Who Qualifies to Claim for Home Health Care Benefits?

As mentioned, there are some requirements to claim home health care through Medicare. Some of the main requirements for claiming are as follows:

  • The home health care treatment must be part of a plan prescribed by a doctor or qualified medical professional.
  • Necessary services can’t be claimed for indefinitely. This means that you can only claim for a set duration of time as prescribed by a qualified health care professional. When the prescribed treatment time expires, eligible candidates need to reapply for care and obtain an extended treatment recommendation from a heath care professional.
  • Home health care services can’t be administered full-time. This means that Medicare won’t pay for 24/7 home health care services.
  • Eligible candidates must be certified as being home-bound by a doctor. To qualify as home-bound, a patient mustn’t be able to leave home without a wheelchair, walking frame or another person to assist. The patient must be able to prove that leaving home requires a considerable amount of effort.
  • The home health care services have to be administered by a home health care agency that’s registered with Medicare.

Lastly, it’s a requirement that Medicare must approve any home health care costs you wish to claim for. You need to make sure that Medicare will pay for your treatments before receiving care from a qualifying home health care agency.

Medicare won’t pay for home health care services if they aren’t administered through a registered home health care agency. Furthermore, Medicare won’t pay if you only require minor household services like cleaning, cooking and shopping. All household tasks must be performed by qualified health aides and they must be part of a prescribed health care plan.

What Kind of Home Health Services Can You Claim For?

Although the above describes what you can claim, you might still feel a sense of confusion. Does Medicare pay for the home health care you need? To clear up confusion, here are some examples of eligible candidates who can claim:

  • Patients who are recovering at home post-surgery qualify for necessary nursing services, such as wound care at home.
  • Patients recovering from a stroke can qualify to receive care from a health aide during the recovery process.
  • Recovering stroke patients, amputees and disabled persons can qualify for rehabilitation, such as physical and occupational therapy.
  • Diabetic patients can qualify for complex wound care after an injury.
  • Elderly patients suffering from temporary illnesses, infections and injuries can qualify for nursing care and health aide services.

Health aides can deliver a variety of services to patients. Qualified home health aides often perform daily tasks such as cooking and cleaning duties on behalf of patients. Home health aides also assist in helping patients with movement impairments move around. Patients with memory problems often need to be reminded to take their prescribed medications, which is another task home health aides can help with.

What Won’t Medicare Cover?

Although Medicare will generally cover almost any home health care services, they won’t cover 24/7 home health care. Severely disabled patients often need 24/7 assistance, with a nurse permanently available. However, this won’t be covered by home health care.

Chronic home health care also isn’t covered. This means that if you have an elderly loved one who is permanently dependent on a health aide, Medicare is unlikely to cover your costs.

Home Health Care Cost vs Traditional Care Costs

Seeing as not all persons in need of home health care can claim from Medicare, the cost of at-home health services compared to traditional options is an important consideration.

For instance, how does home health care costs compare to nursing home expenses? While many people think that home health care is a much more expensive option, it isn’t always the case. In fact, hiring a home health aide to care for an elderly loved one for 40-44 hours a week can cost as little $5000 monthly. Compare that cost to a nursing home, which can cost almost $7000 a month, by comparison.

Keep in mind that home health aides aren’t qualified nurses and can’t administer skilled health care services. A health aide won’t be able to deliver complex wound care. Your health aide also won’t be able to deliver medications through an IV or to tube feed a patient, as these all require the skills of a nurse. If your loved one requires any of the above-mentioned health services, traditional treatment might still be a cheaper option for you.

That said, home health aides are qualified to help patients with daily activities like cooking, cleaning and moving around. Patients who need help getting dressed and eating can also rely on a health aide for care.

So, when choosing whether to opt for home health care vs traditional care, consider what kind of care your loved one needs. If your loved one needs a lot of medical assistance, home care costs might end up being more expensive. But if you have an elderly loved one with dementia who simply requires supervision to stay safe alone at home, home health care can be cheaper than other options.

Rozanne WildsDoes Medicare Pay for Home Health Care?