Medicare covers a variety of services, and some can be provided at home. If your healthcare provider orders any services, items, or additional visits that are not covered by Medicares home health benefits, you may need to cover all or a portion of the costs. Whether your home health care is covered by Part A or Part B, Medicare pays the full cost for services provided by a participating provider.
This means that if you and your provider comply with all of the requirements under Medicare, you will pay no deductible and no coinsurance for home health care. If you require durable medical equipment, like a wheelchair or walker, when receiving home care, these charges are charged separately and are subject to Medicare Part B deductibles and coinsurance.
For example, if you require durable medical equipment like a hospital bed for home care services, Medicare covers just 80% of the cost – leaving you responsible for the remainder. Patients can opt to purchase medical equipment to use at home, in which case Medicare covers the cost, too. For example, Medicare pays for the cost of renting some types of equipment.
Medicare also covers partial-time or intermittent care if you need the skills of a nurse. Medicare Part A also covers providing skilled nursing care through home health services, as long as it is intermittent or part-time. Medicare Parts A and B do provide some coverage for home health services, including a variety of therapies, intermittent skilled nursing, and home health aides on part-time basis.
Only home health care services prescribed by a physician and provided by a qualified attendant are covered under Medicare, but patients must meet certain eligibility requirements. To be covered, a doctor must prescribe home health services, and one of more than 11,000 home health agencies across the country certified by Medicare must provide the care. Medicare will cover licensed or certified attendants if their services are part of the care planned by a home health agency certified by Medicare.
Except for occasional skilled nursing, there is no limit on the number of home visits that Medicare will cover. This timeframe is renewable, meaning Medicare will keep providing coverage as long as your physician recertifies, at least once every 60 days, that the home health services are still medically necessary. To stay eligible for in-home care, you must have seen your doctor less than 90 days before, or 30 days after, starting home health services. If you are admitted to a hospital for 3 consecutive days, or if your Medicare covers you while in a skilled nursing facility, you will have 100 days of coverage for home health services under Part A, assuming that you get the home healthcare services within 14 days after leaving a hospital or nursing facility.
Occasionally, Original Medicare (Part A and Part B) can cover health care provided in your home if you are homebound. Either element of Original Medicare–hospital insurance for Part A, and/or physician visits and outpatient treatments for Part B–may cover care at home. When there is an in-home caretaker, patients might be told that, therefore, Medicare would not cover in-home care because this caretaker would have to perform it. Medicare generally does not cover an in-home caregiver to do personal care or household chores if this is the only care needed.
Whether or not Medicare pays for an in-home carer depends on what type of care you are receiving, why you are needing the care, and how long you will need the care. In-home Caregiving Medicare generally does not cover aides who assist with activities of daily living, unless they are needed for a brief time as you recover from illness or an injury. Care provided by a nurse, such as a respite care provider to a family member, does not require licensed nurse skills (as defined in SS40.1), and thus has no effect on a beneficiaries eligibility for Medicare payments for home health services, although other third-party insurance may cover this care. A senior who is housebound or requires physical therapy, occupational health support, or other medical care services at home can obtain partial payment of home health services costs through Medicare.
You must be homebound and require periodic nursing or some type of therapy, such as physical, speech, or occupational services therapy. You must also be homebound, in medical custody, and require at least one of the services covered by Medicare. For Medicare to cover home health services, your situation must fit into this listing of requirements.
Medicare also sometimes used to require that you have a condition you expected to improve while receiving home health care, but recent changes have allowed you to qualify for home health care simply for maintaining your condition or for slowing the decline in your condition. You can be denied coverage for long-term care services if you are already sick or you have a preexisting condition. Coverage varies from plan to plan, but long-term care insurance generally covers care at home or a nursing facility.
Medicare can cover the following services and items for people who are eligible for this benefit. Medicare must cover these services regardless if your condition is temporary or chronic.
Medicare also pays for an initial assessment from a home health agency, as prescribed by your doctor, to determine whether you are a good candidate for home health services. Medicare will not cover any personal or custodial care, such as bathing, grooming, and assistance using the restroom, if that is the only care you require. If a DME provider does not accept the Medicare payment as full payment, you might be responsible for paying another 20%, plus another 15%, for your own DME. Based on eligibility, Medicare generally pays 80 percent of the approved amount of equipment that your physician orders.
Blackwell has a bachelors degree in nursing from Northern Colorado University, a masters degree in healthcare administration from Grand Canyon University, a post-graduate interprofessional certification in palliative care from University of Colorado Anschutz Medical Campus, and holds the certification as a certified senior advisor(r) from the Association of Certified Senior Advisors.