Home health care encompasses a broad spectrum of medical services delivered in the comfort of your own home, typically addressing illnesses or injuries. Often, receiving care at home is not only more affordable and convenient but also equally effective compared to hospital or skilled nursing facility (SNF) settings.
For those eligible, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) can cover home health services, provided you require Part Time Care or intermittent skilled services and meet the criteria of being “homebound.” Being homebound, in Medicare terms, signifies that:
- Due to an illness or injury, leaving your home independently is challenging without assistance. This assistance could involve mobility aids like a cane, wheelchair, walker, or crutches, specialized transportation, or the help of another person.
- Your medical condition advises against leaving your home.
- Leaving home is typically a significant effort and therefore you are generally unable to do so.
Medicare’s coverage for home health services includes a range of necessary treatments and support, specifically focusing on part time care needs:
- Medically Necessary Part-Time or Intermittent Skilled Nursing Care: This includes essential nursing services delivered on a part-time or intermittent basis, such as:
- Comprehensive wound care for pressure sores or post-surgical wounds to ensure proper healing and prevent infection.
- Detailed education and training for both the patient and their caregivers to manage health conditions effectively at home.
- Administration of intravenous (IV) therapy or specialized nutritional support as prescribed by a physician.
- Delivery of necessary injections for various medical conditions.
- Continuous monitoring of serious illnesses and unstable health statuses to promptly address any changes or emergencies.
- Physical Therapy Services: Personalized physical therapy to help regain mobility, strength, and function, crucial for recovery and independence.
- Occupational Therapy Services: Occupational therapy to assist with daily living activities and adapt your environment to support your abilities and independence.
- Speech-Language Pathology Services: Therapy to address speech, language, and swallowing difficulties, vital for communication and safe eating.
- Medical Social Services: Support from medical social workers to help navigate emotional, social, and financial challenges related to your health condition and care.
- Part-Time or Intermittent Home Health Aide Care: This part time care service is available if you are also receiving skilled nursing care or therapy services. Home health aides provide assistance with personal care tasks, including:
- Support with ambulation and movement to prevent falls and maintain mobility.
- Assistance with personal hygiene, such as bathing and grooming, to maintain cleanliness and comfort.
- Help with changing bed linens to ensure a hygienic and comfortable sleeping environment.
- Support with feeding, if necessary, to ensure adequate nutrition.
- Injectable Osteoporosis Drugs for Women: Coverage for injectable medications to treat osteoporosis in women at risk of fractures.
- Durable Medical Equipment (DME): Coverage for necessary medical equipment like wheelchairs, walkers, or hospital beds to aid mobility and comfort at home.
- Medical Supplies: Coverage for essential medical supplies needed for your care at home, such as bandages and catheters.
- Disposable Negative Pressure Wound Therapy Devices: Coverage for advanced wound care devices that promote healing and reduce infection risk.
To initiate home health care under Medicare, a physician or a qualified health care provider, such as a nurse practitioner, must conduct a face-to-face assessment to certify your need for these services. Your care must be ordered by a doctor or provider and delivered by a Medicare-certified home health agency.
Upon determining your need for home health care, your provider is required to supply you with a list of agencies serving your area. You can also find this information on the Medicare website’s Care Compare tool. Transparency is key, and providers must disclose if they have any financial interests in the agencies they recommend.
The term “part time or intermittent” generally means that you may 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 each week. In situations where medically necessary, you might be approved for slightly more frequent care, up to 35 hours per week, if authorized by your provider for a short duration and still considered part time care.
It’s important to understand what Medicare does not cover in home health care:
- 24-hour care at home: Medicare does not pay for continuous, around-the-clock care in your residence.
- Home meal delivery: Meal services are not covered under home health benefits.
- Homemaker services: Assistance with tasks like shopping and general cleaning, if not directly related to your medical care plan, are not covered.
- Custodial or personal care: If you solely require assistance with daily living activities such as bathing, dressing, or using the bathroom, and do not need skilled care, Medicare home health benefits may not apply.
Eligibility for home health benefits is contingent on needing no more than part time or “intermittent” skilled care. You are still permitted to leave home for medical appointments or short, infrequent outings for non-medical reasons, such as attending religious services. Participation in adult day care programs also does not disqualify you from receiving home health care.
