Life expectancy today is longer than it has ever been before. This is due in large part to advances in medical technology. Yet, while this is a positive in many ways, it also means that, as a whole, many more people will be in need of long term care services.
While many long-term care services are offered in facilities such as skilled nursing homes and assisted care living facilities, the majority of patients – if given the option – would likely prefer to receive their care at home.
Unfortunately for many, the cost of even basic care can be prohibitive. Regular health insurance policies do not pay for custodial and long-term care services – and this includes the expenses that are related to home health care. Medicare, however, will pick up some of these costs.
What Does Medicare Cover for Home Health Care?
Certain home health care services may be covered under Medicare Part A or Medicare Part B. Typically, a home health care agency will coordinate all of the different home health care services that your medical professional orders for you.
If you qualify for Medicare’s home health care services, you will usually pay nothing for the services that you receive. However, you will generally be required to pay 20 percent of the Medicare-approved amount for any durable medical equipment that you receive.
Medicare will not pay for services such as personal care, homemaker services, or meals that are delivered to your home. In addition, Medicare will also not pay for 24-hour per day care that you receive at your home.
There may be times when your doctor or other health care professional recommends services that cost more than what Medicare will cover. These professionals may even recommend that you obtain some services that are not covered by Medicare at all. Should this occur, it is possible that you will be required to pay some or all of the expense out-of-pocket.
How Do You Qualify for Medicare Coverage in a Skilled Nursing Home?
In order to qualify for Medicare’s coverage in a skilled nursing home, you must meet several criteria. These include:
Who is Eligible for Medicare Home Health Care Services?
In order to qualify for Medicare’s home health care coverage, you must meet the following criteria:
You must be under the direct care of a physician
You must be receiving medical services under a plan of care that has been established by a physician and is being regularly reviewed by such
A physician must certify that you need one or more of the following:
Intermittent skilled nursing care (If you need more than just part-time or intermittent care, you will not qualify for Medicare’s home care services)
Either physical therapy, speech language pathology, or continued occupational therapy services
You must be receiving your home health care from a Medicare-certified home health care agency
Your physician must certify that you are homebound (If you are able to leave your home for short trips to the doctor, or to attend religious services, you will still be eligible to receive Medicare’s home health care services).
How Much Does Medicare Cover for Home Health Care Coverage?
Prior to you obtaining any home health care coverage through Medicare, the home health agency that you work with should tell you how much Medicare will be paying for your services and for any durable medical equipment that you will be receiving.
In addition, the home health agency should also let you know if any of the services or items will not be covered, along with the cost of such items. This information should be provided to you in a notice called the Home Health Advance Beneficiary Notice. Upon receiving this notice, you will be able to determine how much your out-of-pocket expenses will be.