Home Health Care Services: Medicare as a Resource

Many of us who fall under the traditional “sandwich generation” category of a caregiver are more than likely looking after someone covered under Medicare. Home health care services can be not only an answer to the needs of your loved one but also a welcome resource to you as the caregiver.

If you or someone you know cares for someone (family member or not) under Medicare, they are covered for certain in-home health care services.

What Is Home Health Care?

Let’s go to the primary source for the definition; Medicare.gov.:

Home health care is a wide range of health care services that can be given in your home for an illness or injury. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility (SNF). 

Examples of skilled home health services include:

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• Intravenous or nutrition therapy
• Injections
• Monitoring serious illness and unstable health status

In general, the goal of home health care is to treat an illness or injury. Home health care helps you:

• Get better
• Regain your independence
• Become as self-sufficient as possible
• Maintain your current condition or level of function
• Slow decline

What are Home Health Care Services?

Medicare.gov states that:

Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) cover eligible home health services like these:

• Part-time or “intermittent” skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Part-time or intermittent home health aide services (personal hands-on care)
• Injectable osteoporosis drugs for women

Usually, a home health care agency coordinates the services your doctor orders for you.

Medicare doesn’t pay for:

• 24-hour-a-day care at home
• Meals delivered to your home
• Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
• Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need.

Who is Eligible for Home Health Care Under Medicare?

Medicare.gov’s website goes on to give you the following “bullet-points” for eligibility if your loved one is covered under Medicare:

All people with Part A and/or Part B who meet all of these conditions are covered:

• You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.
• You must need, and a doctor must certify that you need, one or more of these:
  • Intermittent skilled nursing care (other than drawing blood)
  • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare-certified).
• You must be homebound, and a doctor must certify that you’re homebound. 

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult daycare

What Are the Costs Under Medicare?

I would advise you to read Medicare.gov’s website information about the variations on cost. Below is a general summary of their coverage for costs that the website mentions:

• $0 for home health care services.
• 20% of the Medicare-approved amount for Durable Medical Equipment (DME).

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the Advance Beneficiary Notice” (ABN) before giving you services and supplies that Medicare doesn’t cover.

Conclusion:

U.S. adults age 65 and older are covered under Medicare.

Do your homework with Medicare.gov and other resources to get the most coverage you can for quality home health care!

Additional Resources:

Please read the Medicare.gov website page, “More About Home Health Care.”

In addition, I would encourage you to download and/or print their booklet called “Medicare and Home Health Care.”

“The Unintentional Caregiver.” BalancedAbundantLiving.com. May 25, 2021.

“The ‘Sandwich Generation’: Our Need for Balanced, Abundant Living.” BalancedAbundantLiving.com. June 1, 2021.

Medicare for Dummies. By Patricia Barry. 4^th edition. 2020.

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