Home health care encompasses a broad spectrum of medical services delivered in the comfort of your own home, typically to aid recovery from an illness or injury. Often, receiving care at home is more affordable, convenient, and equally effective compared to similar care received in a hospital or skilled nursing facility (SNF). Medicare, through Part A (Hospital Insurance) and Part B (Medical Insurance), provides coverage for eligible home health services, provided you require part-time or intermittent skilled care and meet the criteria of being “homebound.”
To be considered “homebound” under Medicare guidelines, you must meet one of the following conditions:
- Leaving your home necessitates considerable effort and is typically challenging without assistance. This could be due to an illness or injury that requires the use of mobility aids like a cane, wheelchair, walker, or crutches, the need for special transportation, or the assistance of another person.
- A medical professional advises against leaving your home due to your current health condition.
- You are generally unable to leave your home independently because doing so would be a significant and taxing effort.
Medicare-covered home health services are comprehensive and designed to support your recovery and well-being at home. These services include:
-
Part-time or Intermittent Skilled Nursing Care: This involves medically necessary care provided by registered nurses or licensed practical nurses. Examples include:
- Wound Care Management: Expert care for pressure ulcers, surgical wounds, and other types of wounds to promote healing and prevent infection.
- Patient and Caregiver Education: Comprehensive education and training for patients and their families on managing health conditions, medications, and self-care techniques.
- Intravenous (IV) Therapy and Nutritional Support: Administration of medications, fluids, and nutrients directly into the bloodstream when oral intake is insufficient or not possible.
- Injections: Administering prescribed injections, such as insulin or other medications, as directed by your physician.
- Monitoring Serious Illness and Unstable Health Status: Close monitoring of vital signs, symptoms, and overall health status for individuals with chronic conditions or those recovering from acute illnesses to detect and manage potential complications promptly.
-
Physical Therapy Services: Personalized programs designed to improve mobility, strength, balance, and coordination. Physical therapists help patients regain function after surgery, injury, or illness, and manage conditions like arthritis or stroke.
-
Occupational Therapy Services: Focuses on helping individuals regain the ability to perform daily living activities. Occupational therapists assist with tasks like dressing, bathing, eating, and cooking, and recommend adaptive equipment to enhance independence.
-
Speech-Language Pathology Services: Addresses communication and swallowing disorders. Speech therapists help patients improve speech, language, voice, and swallowing skills, often necessary after a stroke, head injury, or due to conditions like Parkinson’s disease.
-
Medical Social Services: Provided by licensed social workers to address the emotional and social needs related to illness and recovery. Services may include counseling, resource planning, and assistance with accessing community support services.
-
Part-Time or Intermittent Home Health Aide Care: Personal care assistance provided by certified nursing assistants or home health aides. This service is covered by Medicare only when you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy concurrently. Home health aides can assist with:
- Mobility Assistance: Help with walking, transferring from bed to chair, and other mobility needs to ensure safety and prevent falls.
- Personal Hygiene and Grooming: Assistance with bathing, dressing, grooming, and other personal hygiene tasks to maintain cleanliness and comfort.
- Changing Bed Linens: Maintaining a clean and healthy home environment by changing bed linens.
- Feeding Assistance: Help with eating for individuals who have difficulty feeding themselves.
-
Injectable Osteoporosis Drugs for Women: Medicare covers injectable osteoporosis medications for women at risk of fractures, provided specific criteria are met.
-
Durable Medical Equipment (DME): Coverage for medically necessary equipment that can withstand repeated use, such as wheelchairs, walkers, hospital beds, and oxygen equipment, to aid in mobility and function at home.
-
Medical Supplies for Home Use: Coverage for consumable medical supplies needed for treatment at home, such as wound dressings, catheters, and ostomy supplies.
-
Disposable Negative Pressure Wound Therapy Devices: Medicare covers these advanced wound care devices for specific types of wounds to promote faster healing.
To initiate Medicare Home Health Services, your physician or another authorized health care provider (like a nurse practitioner) must conduct a face-to-face assessment to confirm your need for home health care. A doctor’s order is required for your care, and the services must be delivered by a Medicare-certified home health agency. Your provider is obligated to provide you with a list of Medicare-certified home health agencies in your area and disclose if they have any financial interest in any of the listed agencies. You can also find agencies in your area through the Medicare Care Compare tool.
“Part-time or intermittent” care typically means you can receive skilled nursing care and home health aide services for a combined total of up to 8 hours per day, with a maximum of 28 hours per week. In certain situations, if deemed medically necessary by your provider, you may be eligible for more frequent care for a short duration, up to but not exceeding 8 hours daily and 35 hours weekly.
It’s important to understand what Medicare does not cover under home health benefits. Medicare does not pay for:
- 24-hour-a-day care at home: Continuous, around-the-clock care is not covered under the home health benefit.
- Home meal delivery services: Meals delivered to your home are not a covered home health service.
- Homemaker services unrelated to your care plan: Services like general house cleaning or shopping that are not directly tied to your medical care plan are not covered.
- Custodial or personal care when it’s the only care needed: If you solely require assistance with daily living activities such as bathing, dressing, or using the bathroom, and do not require skilled medical care, this level of care is not covered under the Medicare home health benefit.
If your care needs exceed part-time or intermittent skilled care, you may not be eligible for the home health benefit. However, you are permitted to leave your home for medical appointments or short, infrequent outings for non-medical reasons, such as religious services, without jeopardizing your home health care eligibility. Attendance at adult day care programs is also permissible while receiving Medicare home health care.
