An Overview of What Home Health Care is Covered by Medicare

what home health care is covered by medicare

As people age, more are turning to home health care providers for assistance with daily tasks like bathing and cooking. Not all caregivers are Medicare-certified; consequently, seniors may be uncertain of the costs associated with these services. Luckily, most home health care services are covered under Original Medicare or a Medicare Advantage plan which meets certain requirements; in this article we’ll give an overview of this coverage so you can make an informed decision as to whether this service fits into their life circumstances.

Medicare only covers home health care that is medically necessary, making consultation with your physician before seeking home health assistance or already receiving assistance essential. Furthermore, its important to remember that Original Medicare benefits differ from Medicare Advantage plans with home health coverage in terms of benefits and guidelines for caregiving assistance.

Since most Medicare Advantage plans do not cover custodial care, you may require Medicaid as a source of coverage. This state and federal program provides coverage to low-income individuals; before making this application it would be wise to conduct thorough research into all of your available options before applying.

Medicare covers many forms of home health care services and supplies for its beneficiaries, including skilled nursing, physical therapy, speech-language pathology and some medical social services. Medicare Advantage plans often offer additional home health services and supplies like durable medical equipment (typically up to 80% of what Medicare covers) and some home delivery medications.

Medicare home health care requires at least three days spent in either a hospital or skilled nursing facility (SNF) as well as meeting additional eligibility criteria; specifically homebound criteria where leaving your house takes significant effort or cannot be done regularly. To qualify, Medicare requires at least three days spent hospitalized or an SNF and that you meet other criteria of eligibility – in particular homebound criteria which states leaving home requires considerable effort or is impossible regularly.

Your doctor must create and regularly review a plan of care to outline which services are necessary in your home environment. Medicare then works with an approved home health agency to provide these services.

As soon as you begin receiving home health services, your home health agency should inform you if any supplies or services aren’t covered by Medicare. This should be provided via an Advance Beneficiary Notice (ABN). If you disagree with their decisions about what will or won’t be covered, you have the right to file an appeal and file one if needed; keep in mind though, durable medical equipment and supplies still must meet their respective Medicare Part B deductible payments.

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