Medicare Coverage for Home Health Care Under Federal Law
Home health care has become a popular option as elderly people increasingly choose to complete their recovery from an illness outside a hospital or nursing facility. It can allow them to reduce costs while gaining the emotional boost of living in a familiar setting, with the flexibility and privacy that it offers. Home health care agencies provide a streamlined form of care to patients, consisting of sporadic nursing or therapy services rather than the intensive monitoring found in hospitals. You can ask your doctor or the discharge planner at the hospital for referrals to home health care agencies, or you can explore lists of agencies that are provided by community organizations, senior centers, or nursing associations. The list on the Medicare website contains evaluations of these agencies that may help you sort them by quality.
This type of care is not the right solution in every situation, though. A patient should make sure to remain in the hospital until their condition stabilizes. Hospitals and insurers sometimes urge patients to leave before they are ready, which can cause serious problems. Premature discharge can prove especially dangerous if a patient does not live in an area near family members or friends. This will force them to rely heavily on the home health care agency, which may not be equipped to meet all of their needs.
Eligibility for Medicare Coverage
You may be able to get Medicare to cover the costs of home health care if you use an agency that is approved by Medicare. To qualify for coverage, you would need to be able to show that your doctor prescribed home health care and will be coordinating your care with the agency. You must not be able to leave your home due to an illness or medical condition. Approved forms of home health care may include part-time skilled nursing care or physical, speech, or occupational therapy. (Medicare may cover full-time nursing care if you need it, but it will not cover home health care in that situation.) You do not need to show that home health care will improve your condition.
If you qualify for Medicare coverage for home health care and have spent at least three days in the hospital, Medicare Part A will cover unlimited home visits. If your doctor asks you to undergo an evaluation to determine whether home health care would be a good fit, Medicare Part A will cover the cost of the evaluation as well. If home health care does not follow a hospital stay that lasted at least three days, Medicare Part B will cover its costs instead. As long as you are receiving part-time nursing care or physical, speech, or occupational therapy, Medicare also will cover the costs of medical supplies related to home health care, medical social services, and any personal care provided on a part-time basis by members of the home health care agency. It will cover 80 percent of the cost of any durable medical equipment that you need.
On the other hand, you should be aware that Medicare does not cover all of the services that a home health care agency may provide. It does not cover meals or housekeeping services, and it does not cover medications provided by the home health care agency. It covers only part-time nursing care rather than full-time nursing care. It covers personal care only if this is not the only form of home health care that you receive.
