Home Healthcare Services provide a wide range of medical care in the comfort of your own home. These services offer a convenient and often more affordable alternative to hospital or skilled nursing facility care for individuals recovering from illness or injury.
Understanding Home Healthcare Services Eligibility
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) may cover eligible home healthcare services if you meet specific criteria. You must require part-time or intermittent skilled services and be considered “homebound.”
Being homebound means:
- Leaving home requires considerable effort or assistance due to illness or injury. This could involve using mobility aids like a cane, wheelchair, or walker, needing special transportation, or relying on help from another person.
- Your medical condition makes leaving home inadvisable.
- Leaving home is generally not feasible due to the significant physical exertion required.
Covered Home Healthcare Services
A variety of services may be covered under home healthcare, including:
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Skilled Nursing Care: This encompasses services like wound care, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring of serious illnesses.
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Therapy Services: Physical therapy, occupational therapy, and speech-language pathology services can help patients regain lost function and improve their quality of life.
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Medical Social Services: These services address the social and emotional aspects of illness and recovery, providing support and resources to patients and their families.
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Home Health Aide Care: Assistance with activities like walking, bathing, grooming, changing bed linens, and feeding can be provided if you are also receiving skilled nursing care or therapy services.
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Other Covered Services: Injectable osteoporosis drugs for women, durable medical equipment, medical supplies for home use, and disposable negative pressure wound therapy devices.
Getting Started with Home Healthcare
A doctor or qualified healthcare provider must conduct a face-to-face assessment to determine your need for home healthcare services. They will then order the necessary care, which must be provided by a Medicare-certified home health agency. Your provider should offer a list of agencies in your area and disclose any financial relationships with those agencies.
Typically, “part-time or intermittent” care allows for up to 8 hours of combined skilled nursing and home health aide services per day, with a maximum of 28 hours per week. In certain situations, more frequent care may be authorized for a short period if deemed medically necessary.
Services Not Covered by Home Healthcare
Medicare does not cover the following:
- Round-the-clock home care
- Home meal delivery
- Homemaker services (e.g., shopping, cleaning) not related to your care plan
- Custodial or personal care for daily living activities (e.g., bathing, dressing) if this is the only care required
You may not qualify for home healthcare benefits if your needs exceed part-time or intermittent skilled care. However, leaving home for medical treatment or short, infrequent non-medical absences (such as attending religious services) will not disqualify you. Participating in adult day care is also permissible while receiving home healthcare.
