How to Use Medicare for Home Health Services

homebound medicare health service

With advances in technology, it is now even easier for doctors to deliver healthcare services to you in your home. The good news is that Medicare will cover many of these services for homebound patients. The hope is that the more doctors can visit homebound patients, the less patients will be admitted to the hospital for emergency situations.

What does Medicare cover?

A home health agency will arrange for the services that a doctor orders for you. Medicare Part A and/or Medicare Part B covers home health services like:

  • Intermittent skilled nursing care
  • Physical therapy
  • Speech-language pathology
  • Continued occupational services

What are the regulations?

These home health services are available to people under these conditions:

  • You must have Medicare Parts A and B.
  • You must be under the care of a doctor.
  • A doctor must certify that you need intermittent (less than seven days a week or less than eight hours per day for 21 days or less) skilled nursing care, physical therapy, speech-language pathology, or continued occupational services. There are more restrictions in coverage, such as your condition must be expected to improve and you need the services of a skilled therapist to maintain function.
  • The home health agency must be Medicare-certified (not a family member or independent caregiver).
  • You must be homebound, and this condition must be certified by a doctor. You may still leave home occasionally for non-medical reasons and/or adult day care.

The costs for such home health services are $0, and 20% of the Medicare-approved amount for durable medical equipment needed for home health care.

When is home health care needed?

Home health care is helpful in scenarios such as when a wound needs to be tended or intravenous feeding or injections are needed. If you are looking to save money or if it is difficult to get your loved one to the doctor, home health care might be a good option.

Vet your agency first

It’s a good idea to vet your home health agency to make sure they fit the requirements and offer everything you need. The government’s Medicare site provides this checklist when choosing your home health care agency. Also, before starting home health care, be sure your agency tells you what will and will not be covered by Medicare and how much Medicare will pay. The agency should give you a written notice called the Home Health Advance Beneficiary Notice (HHABN) before providing any non-Medicare-covered services.

What Medicare will not cover

Note that Medicare does not pay for:

  • 24-hour-a-day at-home care
  • Meals delivered to your home
  • Homemaker services
  • Personal care

Medicare does not pay for long-term at home care, such as for someone with Alzheimer’s or dementia or someone who needs round-the-clock care. Medicare does cover hospice care for those who are terminally ill and skilled nursing care for 100 days in certain situations.

Related Links

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The new Medicare Plus Card saves you up to 75% on things not covered by Medicare

Medicare doesn’t cover everything. Luckily, those on Medicare can now start saving on out of pocket expenses like prescription drugs, dental, vision, hearing, and more. Over 1 million people have already received their free Medicare Plus Card.

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