4 Seniors: Does Medicare Cover Home Health Care?

OKLAHOMA CITY (KFOR) – Home health care services are a valuable benefit of Medicare which provides a wide variety of part-time or intermittent home nursing, therapy and other supports to beneficiaries in need, if they meet Medicare criteria. This is how it works.

In order to provide home health care coverage, Medicare first requires you to be homebound. This means that it must be extremely difficult for you to leave the house and that you need help to do so, whether it is from another person or from a medical device such as a cane, wheelchair, walker or crutches.

You will then need to meet with your doctor in person to get a home health certificate confirming that you need qualified nursing care or qualified therapy services from a part-time physical therapist or speech language pathologist.

Your doctor may also request the services of an occupational therapist and a nurse’s aide to help with activities of daily living such as bathing, dressing, and using the toilet. Your doctor must renew and certify your home health insurance plan every 60 days.

You will also need to use a Medicare-certified home health agency.

If you meet all of the conditions, Medicare should pay for your home health care.

But be aware that Medicare will not only pay for assistance with personal care (washing, dressing, going to the bathroom, etc.) if it does not also need nursing services. or qualified therapies. Housekeeping services, such as shopping, meal preparation and cleaning, are also not covered.

If you have original Medicare, you can locate a Medicare-certified home care agency by calling 800-633-4227. If you have a Medicare Advantage plan, you should contact your plan directly and ask which home health agencies work with the plan and are part of the plan’s provider network.

For more detailed information on how Medicare covers home health care, see the online “Medicare and Home Health Care” booklet.

Other options

If you do not qualify for Medicare home health care coverage, there are other coverage options depending on your situation. Here are several that may apply to you:

Assurance: If you have long term care insurance, check to see if it covers home care. Or if you have a life insurance policy, see if it can be used to pay for care.

Medicaid: If your income is low, you can take advantage of Medicaid (SoonerCare), which offers “home and community service” waivers that can pay for home care. To investigate this, contact your local Medicaid office.

Also check out PACE, which stands for “All Inclusive Care Programs for the Elderly”. PACE provides home care, including assistance with activities of daily living, such as meals, dental and medical care, among other benefits.

Benefits for Veterans: If you are a veteran, the VA also offers some perks that can help you. Two programs to inquire about are “Home Help and Assistance or Allowances” and the “Veteran-Led Care” program. Both programs provide monthly financial benefits to eligible veterans who can help pay for home care. For more information, contact your regional VA benefit office or call 800-827-1000. To find these and other programs in your area that can help pay for home care, go to PayForSeniorCare.com and click on “Find Financial Assistance for Care” to access their Elderly Care Financial Assistance Finder.

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