Everything You Need To Know About Medicare Home Health Services

More than 60 millions American use Medicare as their primary health insurance. And every year, this number grows. That’s because Medicare is a national program that aims to lower healthcare costs for the most vulnerable people. Yet, Medicare provides many services that Americans may be unaware of, such as home health care. In fact, Medicare home health services are already accessible to millions of Medicare users. 

This article will tell you all about what these services include and who qualifies for them.

Who Qualifies for Medicare Home Health Services?

To qualify for Medicare home health services, you need to meet five targets. First, you need to be homebound. This means it’s challenging for you to leave your home. Then, when you do go out, you need assistance from a person or device such as a wheelchair or walker. 

Next, you must require skilled nursing services or therapy care on an occasional basis. Professional therapy services include:

  • Physical therapy
  • Speech therapy 
  • Occupational therapy

Medicare defines “occasional” as needing care at least once every 60 days and at most once a day for three weeks. The period can be longer if you require more care. However, your needs must be predictable and limited. 

Additionally, Medicare defines “skilled care” as care that needs to be performed by a professional or under the supervision of a professional. 

Then, you need to have a face-to-face meeting with your doctor within 90 days before you begin home healthcare services. You can also meet with your doctor up to 30 days after the first day you start receiving care. Your meeting must be within this time frame.

Face-to-face meetings include:

  • Office visit
  • Hospital visit 
  • Video conferencing 

After the meeting, your doctor needs to sign a home health certification. This certification confirms that you are homebound and need occasional skilled care. It also must state that your doctor approved the plan of care for you. Additionally, it should say you met the requirement of having a face-to-face meeting.

Finally, you need to receive care from a Medicare-certified home health agency (HHA). If you can meet all five of these conditions, you are eligible for Medicare home health services. 

Who Doesn’t Qualify?

You won’t qualify for home health services if you only need occupational therapy. But, if you meet the qualifications on another basis, you can include occupational therapy in your care.

How Does Coverage for Home Health Service Work?

As mentioned, your doctor will need to order home health Medicare services for you. Medicare home health care includes health and social services delivered in your home. 

There are more than 11,000 home health agencies in the US that are Medicare-certified to provide these services. Medicare can cover the total cost of home health services for up to 60 days at a time.

Plus, the period is renewable. So if your doctor continues to recertify the care, Medicare will continue to provide coverage. However, your doctor will need to recertify the plan at least once every 60 days for continuous coverage.

Benefits Included in Home Health Service

There are parts of original Medicare that can cover Medicare home healthcare. Original Medicare includes Parts A and B. Part A is hospital insurance. Part B is doctor visits and outpatient treatment. 

Let’s take a look at the services home healthcare can provide. 

Skilled Nursing Care

On a part-time or occasional basis, Medicare will cover nurses to:

  • Change wound dressings
  • Aid with tube feeding
  • Inject medicine

But, your combined home nursing and personal care needs should not exceed eight hours a day or 28 hours a week. Some limited circumstances can override this rule. You will need to speak with your doctor and healthcare representative.

Therapy

Medicare will provide professional occupational, physical, and speech therapists to restore or improve your ability to:

  • Perform everyday tasks
  • Speak
  • Walk after an illness or injury
  • Help keep your condition from getting worse

As previously discussed, your doctor needs to certify that you require one or more of these services on a part-time basis. The formal documentation will allow you to receive these services under Medicare coverage.

Home Health Aids

Those who need part-time or occasional assistance with personal activities because of their illness or injury can access a home health aid. Aids help with actions like bathing, dressing, or going to the bathroom. 

But, Medicare only covers this service if you will also be receiving skilled nursing or therapy.

Medical Social Services

If you’re receiving skilled care, you can also receive counseling for social or emotional concerns. However, they still need to be related to your illness or injury. Medicare coverage can also help you find community resources should you need them. 

Medical Supplies

Your home health agency can provide supplies like catheters and wound dressings related to your injury or illness. Sometimes the agency can provide walkers or wheelchairs too.

However, Medicare will not cover the total cost of durable medical equipment. As a result, patients are usually responsible for 20% of the Medicare-approved amount.

What Medicare Home Services Don’t Cover

If you only require homemaker or personal care services, Medicare will not pay for them. These include assistance with:

  • Shopping
  • Cleaning
  • Laundry
  • Bathing
  • Dressing
  • Going to the bathroom

Additionally, Medicare home health services don’t cover 24-hour-a-day home care. Meals delivered to your home are also not included. If you require these services, they will have additional costs.

It’s best to speak with your doctor and healthcare representative to know what your Medicare plan will provide for you. The available services may differ between those with original Medicare (Parts A and B) and those with a Medicare Advantage plan. 

Talk to Your Doctor

To take advantage of Medicare home health services, speak with your doctor. There are several benefits already available to you by setting up an appointment and going over the details together. 

If you found this article helpful, make sure to check out more related content in the Health section.