What is home health care?
Home health care involves part-time or intermittent clinical care provided in your own home by health care professionals. It’s intended to help people who are homebound due to illness or injury regain as much independence as possible.
People sometimes confuse home health care, which is provided by skilled professionals, with home care, which is non-skilled or non-clinical care focused on support with activities of daily living (ADLs). Medicare does not typically cover home care.
If you’re looking for a plan that covers home care, long-term care insurance could be an option. These plans cover extended care in a variety of settings and can be relatively affordable if you apply in your early 50s or while in good health. Medicaid can also cover these services, provided you meet the program’s income requirements for your state.
Who qualifies for home health care services?
You may qualify for home health care services if you are homebound and need skilled care in your home on a part-time or intermittent basis as a result of a medical condition, illness, accident or surgery.
Medicare defines homebound as having difficulty leaving home without assistance from another person, special transportation or a mobility aid. In addition, a doctor, physician, nurse practitioner or other health care professional must certify that you are homebound and require home health care services.
People who receive home health care services may be living with a chronic condition like diabetes or Alzheimer’s Disease. Others may be experiencing a temporary situation, such as a recent hospitalization for surgery or due to a medical emergency.
Note that you can still qualify for home health care even if you attend adult day care. Additionally, while receiving home health care, you are permitted to leave your home for occasional medical treatments or religious services.
Does Medicare cover home health care?
Medicare covers home health care under Original Medicare, which includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You can receive home health care up to seven days a week but for no more than eight hours per day or 28 total hours per week. (In some special cases, you may be approved for up to 35 hours per week.)
To receive home health care through Medicare, a doctor, nurse practitioner or other health care professional must certify that you need the service. Additionally, home health care services must be provided by a Medicare-approved home health agency.
If you are enrolled in a Medicare Advantage Plan (Part C), you can access the home health care benefit. However, eligibility requirements and restrictions may be different than those stipulated by Medicare for Part A and Part B. Speak with your health insurance company to find out how to qualify and if you’ll incur any out-of-pocket costs. The company can also provide you with a list of approved home health agencies.
What home health services are not covered by Medicare?
Some home health services are not covered by Medicare. These include:
24-hour care in your home
Meal delivery
Homemaker services, including cleaning and shopping, unless related to your care plan
Custodial or parental care (if it’s the only care you need)
Not that if you only need occupational therapy, you may not be eligible for home health care. You must receive home health care in order to be provided occupational therapy. Additionally, if your doctor believes you require a higher level of care, such as inpatient treatment at a skilled nursing facility, you might be ineligible for home health care.
You should verify costs with the home health care agency before each period begins. If the home health care agency doesn’t cover certain costs, they should provide you with this information in writing through an Advance Beneficiary Notice (ABN). You should receive this notice before the agency provides any services or supplies that Medicare will not pay for.
Additionally, if you live in Florida, Illinois, Massachusetts, Michigan or Texas, you may be able to submit a request for pre-claim review of coverage through the Medicare demonstration program.
