Home health care includes several services that can be completed at home with a healthcare professional. It can be a more convenient option for many people while they heal from an injury or illness. They get to stay in the comfort of their own home while they complete the necessary services ordered by their doctor. If you have consulted with your doctor about home health care, here is what you need to know.
Medicare Coverage for Home Health Care
Medicare Parts A and B can cover home health care services. If you need home care after a three-day hospital stay or skilled nursing facility stay, Medicare Part A will help cover your home care services. However, if you haven’t had a hospital stay and your doctor orders home health care services, Medicare Part B will help cover the cost for you.
Understanding the basics of Original Medicare can help you grasp how Medicare works and what it covers. If you are helping your parents understand Medicare, their coverage, and options, visit boomerbenefits.com/a-comprehensive-guide-on-helping-your-parents-apply-for-medicare for additional information.
Home health care is more complicated than other Medicare services because it can be covered by Part A and Part B.
Home Health Care Services Covered
There are certain services you can be eligible for under home care. These services include:
- Part-time skilled nursing care
- Physical therapy
- Medical social services
- Occupational therapy
- Speech-language services
- Home health aide
- Osteoporosis drugs for women
- Durable medical equipment
However, to be eligible for these home care services, your doctor must create a care plan and review it regularly. Additionally, you must need intermittent skilled nursing care or some kind of therapy (i.e., physical, occupational, speech-language) and be homebound. Your doctor should refer you to a home health care agency that will help schedule your services.
Home Health Care Services Not Covered
Although Medicare covers medically necessary services needed to treat, diagnose, or monitor a health condition, there are some services Medicare does not cover. Regarding home care, Medicare does not cover custodial care, 24-hour care, meals, and other daily homemaker services. If you or someone you know needs help with their laundry, using the bathroom, or cleaning, Medicare will not cover those.
Medicare will help cover medical services that help you get better and have the strength to be independent and self-sufficient.
Your Costs for Home Health Care
Your costs for these services will depend on which part of Medicare is providing coverage and what supplemental plan you’re enrolled in. Part A will cover if you are getting home care services after a qualifying inpatient hospital stay. That means you will first pay the Part A deductible, which is $1,556 in 2022 and should not have other Part A costs.
If Medicare Part B covers the home health care services, you’ll need to satisfy the Part B deductible of $233 in 2022 and pay 20% coinsurance for approved services and equipment. However, Medicare pays the home care agency for your services, and the agency should give you all the cost information before you start the home care services.
Let’s say you’re enrolled in an Advantage plan. In that case, your cost-sharing will vary based on your plan. You can refer to your plan’s Summary of Benefits document to learn more about home health care and what your potential out-of-pocket costs are.
Home health care is an excellent alternative to getting your care. You can stay in the comfort of your own home and get the assistance you need to recover. If you think you qualify for home care, you can consult your doctor to see if it is something you can get through Medicare.