Month: May 2023

If you or a loved one is looking for home health care services in your area, it can be difficult to know how to start, where to go, or how to pay for it. In 2021, Medicare made up 10% of the federal budget, amounting to $689 billion spent. It paid for various medical services, including home health care. When searching for home health care, be sure to check what you’re eligible for through Medicare. We’ll explore what Medicare is, what home health is, and how Medicare can cover home health care.

What is Medicare? 

Medicare is a federal health insurance program designed for individuals over the age of 65, with certain additional eligible populations, including people living with disabilities, for example. 

Medicare comes in several parts, and they include the two core parts of original Medicare:

• •Part A: Hospital insurance.
• •Part B: Medical insurance.

Other parts of Medicare you may get include:

• •Part C: Medigap or Medicare Advantage (MA) plans.
• •Part D: Prescription drug plans. These can be part of original Medicare or Medicare Advantage but are purchased separately.

Medicare, however, differs in several ways from Medicaid. While Medicare eligibility is mostly based on a person’s age, Medicaid eligibility is primarily based on a person’s income. You may be eligible for both. Learn more about Medicaid vs. Medicare here. 

What is home health care?

Home health care, also known as skilled care or skilled care at home, is a type of medical care delivered by trained clinicians (mostly nurses) in the home. Home health care can also occur in a senior living community or wherever an older adult calls home. 

Home health care covers a wide variety of services. This can include: 

• •Wound care.
• •Infusions or injections.
• •Medication administration.
• •Physical or occupational therapy.
• •Personal care assistance.

This could also include coordinating durable medical equipment and other needed supplies to deliver to the home. 

Home health care can be used in a variety of situations. Other circumstances where a person can get home health care include pediatric care, care after a car accident, or rehab following a fall. There are no age restrictions or limitations on who can receive home health care.  

What home health care services does Medicare pay for?

Medicare does cover home health care services under Parts A and B in original Medicare. There are, however, limitations on what will be covered and when. 

Medicare will cover home health care services when the following criteria are met: 

• •Your doctor says that you need medical care at home.
• •You demonstrate the need for one or more service lines under the home health care category, including skilled nursing care, physical therapy, occupational therapy, or speech therapy.
• •You have a physical limitation or another restriction that limits your ability to leave the home without assistance.
• •A company certified by Medicare provides the care you receive.

Once you are eligible and receive these services, there are limitations on the time period that you’ll receive services. Medicare only covers home health care on a part-time and intermittent basis.

However, the services can continue if you continue to demonstrate a need that your doctor can sign off on. There is not necessarily a maximum length of time that Medicare will pay for home health care, but you must require the assistance. 

Every 60 days, providers send a summary of what they’ve done for a physician to review. The care recipient must be recertified every 60 days to continue to receive continuous care. 

There are no out-of-pocket costs associated with covered home health care services through Medicare; however, after you meet your Medicare Part B deductible, you are responsible for paying 20% of the Medicare-approved cost for that service or product. 

According to the Centers for Medicare & Medicaid Services (CMS), the average annual deductible for Part B in 2023 is $226. The average monthly premium for 2023 is $164.90. 

Although Medicare home health services include personal care (which is nonmedical), Medicare will not cover 24-hour care services or services that don’t contribute to your skilled care plan.

When a doctor notifies you that you need skilled care services, this could come as a certificate of medical necessity. Once you have that, identify a Medicare-certified provider to meet your needs. Be sure to keep their National Provider Identifier (NPI) number for your own records. They can share if any of the services you’ll need won’t be covered or if there are any additional costs in writing. The provider will coordinate with Medicare and bill them for services rendered. 

What home health care services does Medicare Advantage (Medicare Part C) cover?

Older adults can also choose a Medicare Advantage (Medicare Part C) plan. Medicare Advantage (MA) plans cover home health care just as original Medicare does, as they’re obligated to offer the same core Part A and Part B benefits with a few exceptions. 

Those exceptions include certain clinical trials and hospice care, which you’ll still be eligible for even with MA. 

Medicare Advantage plans offer many supplemental benefits that can complement home health care to improve a member’s experience. This includes population-specific coverage, like plans for Veterans, plans for people living with diabetes, and plans for people who are dually eligible for Medicare and Medicaid. Some of the unique features of MA plans may include:

• •Respite care/private duty home care.
• •Lawn care.
• •Grocery support.
• •Transportation.
• •Apple watches.
• •Fitness programming.

If you’re considering a Medicare Advantage plan to replace original Medicare, research what plans are available in your area. It’s also important to check if your doctors accept Medicare Advantage before you switch. 

Home health care is a broad service category that is covered under Medicare. If you need home health care services or are looking on behalf of someone else, Medicare is a great first step. 

An estimated seven in 10 adults aged 65 and over will need some form of long-term care support when it comes to their activities of daily living. In-home care is a common solution to meet that need. Paying for care can become an important criterion when shopping for the right senior care. It may be possible for Medicare to pay for in-home care if you need long-term care services at home. 

Here, we explain Medicare and home care and how Medicare may cover your home care costs.

What is Medicare?

Medicare is a federal health insurance program administered by the United States Department of Health and Human Services that covers various long-term care costs for older Americans. It is made up of four parts, each covering a specific aspect of care that members are eligible to receive.

Part A, for example, is for hospital insurance, covering not only parts of inpatient hospital stays but also hospice services, skilled care services, and more. 

Parts A and B of original Medicare are its core components. Part C is an alternative to original Medicare. A Medigap policy or Medicare Advantage (Medicare Part C) plan could be included in that category. Finally, if you have original Medicare or Medicare Advantage, you can purchase a Part D prescription plan as an add-on to help cover the cost of medications.

What is home care? 

Home care is a nonmedical in-home service generally provided by trained caregivers who work with licensed home care agencies. The process of receiving home care generally starts with an in-home assessment to go over a care plan and a schedule and to match your preferences to a caregiver.

Providers also review important policy and operational information, covering information like what happens in the event of a caregiver callout or how to get in touch with the agency outside of core working hours. 

Home care is generally divided into two core service lines, including companion care and personal care. 

Companion care includes assistance in instrumental activities of daily living (iADLs), which include tasks like getting the mail, meal preparation, and socialization. On the other hand, personal care includes assistance with activities of daily living (ADLs), like bathing, dressing, and transferring. 

More than 420,000 home care agencies nationwide help seniors age in place. Some home care agencies may have home health care or hospice providers. They may also have a referral partner relationship if a client’s care needs exceed their nonmedical scope of work. 

Home care services are generally long-term, custodial care arrangements, whereas Medicare’s core offerings lie in skilled/medical, intermittent care arrangements. 

Does Medicare pay for home care services?

Because Medicare is health insurance, it covers medical costs. As mentioned above, home care services are not medical in nature, so Medicare may not cover home care services if they aren’t related to medical costs. However, Medicare may cover long-term care services depending on the level of care needed and the duration that you’ll need it for. Many covered services require prior authorization or approval, like skilled nursing care in a facility or durable medical equipment. 

Medicare will cover medically necessary services, and since home care is nonmedical, the need for home care alone is insufficient for coverage. But if the need for home care is present along with a skilled care need, like getting a wound dressed, that could become covered under home health services. These differ from home care, and you can learn more about the differences here.

Alternatively, Medicare Advantage (Medicare Part C) covers important senior care services, making it an attractive option for many over original Medicare. Over 1,000 plans are now offering some form of in-home support to their members through provider network relationships with local home care providers. It’s important to fully understand a Medicare Advantage plan’s coverage before opting out of original Medicare Parts A and B. Be sure to talk with your potential provider to learn all the details.

The amount of home care hours Medicare will cover depends on a wellness or physical assessment and the extent of the coverage available. In-home support through a Medicare Advantage plan could also include home modifications, meal delivery, respite care, transportation, lawn care, pest control services, and more. 

How to pay for home care

Outside of Medicare Advantage (MA) and Medicare, there are a variety of ways that you can pay for home care services, including: 

• •Long-term care insurance (LTCi).
• •Veterans Aid and Attendance benefit.
• •Medicaid waiver programs. 
• •Workers’ compensation programs. 
• •Religious or cultural programs.
• •Program of All-Inclusive Care for the Elderly (PACE).
• •Reverse mortgages. 
• •Medicaid waiver/CDPAP programs.

Home care is an important service, and if you have concerns about being able to afford it, be sure to check out these payment solutions. 

Medicare doesn’t pay for home care by itself, but you might benefit from various covered programs. There are also various ways to offset the financial costs of in-home care.