Depending on the situation, Medicare may cover medical care given to you if you are homebound or if you need assistance with daily needs for a short time regarding illness or injury. But it is important to know that if you are in need of long-term help, Medicare usually does not cover that service. If Medicare will pay for in-home caregivers depends on a few factors: the reason why you need care, the kind of care you need to receive, and the length of time care services are needed.
In-Home Care Eligibility
A beneficiary must be deemed homebound by a medical provider to receive coverage for in-home care services. Homebound suggests that a patient is unable to leave their house to receive medical care. However, if a beneficiary is enrolled in an adult day care program, they are still able to receive home health care.
If you are homebound regarding illness or injury, you might be eligible for in-home health services if:
- You cannot leave home, except for short outings
- Your doctor verifies that you need in-home care services and writes a plan with all the care services you would need
- You need skilled nursing care (limitation: less than 8 hours per day and no more than 28 hours per week, for up to 3 weeks)
- Your doctor thinks your condition will improve in a reasonable amount of time
- You need a skilled physical, occupational, or speech therapist to help you improve your current state or keep it from getting worse
- You need a home health aide to help care for you while you recover
- The home health agency providing you with care services is Medicare-approved or Medicare-certified
In-Home Care Services
If it is deemed medically necessary, beneficiaries may use the following services:
- Physical therapy
- Occupational therapy
- Speech therapy
- Nursing care
- Home health aides
- In-home social services
If a physical therapist treats you at home, Medicare will pay for the assessment of your current condition, walking training and exercises that will help you recover from surgery, injury or neurological conditions (stroke, etc), postoperative wound care, and wound care from injuries, burns, and lesions.
From occupational therapy you will get the following services: help with setting daily routines for taking medications and planning meals, strategy training to preserve your energy and reduce stress, teaching you how to carry out daily tasks and activities safely, help you regain the ability to function normally regarding your condition, and help you follow the doctor`s instructions.
If a speech therapist works with you at home, you can expect to receive the next services: help with remembering or recognizing words and symbols, therapy that helps you regain the ability to swallow and eat and drink as normally as you can regarding your condition, education about alternative ways of communication if you are not able to speak or hear.
Under nursing care covered by Medicare goes services like changing your wound dressings, changing catheter, injecting needed medications, helping with tube feeding, administering IV medications, and educating yourself about how you can take your medications alone.
Home health aides will help you with monitoring your vital signs (heart rate, blood pressure, and body temperature), making sure you are taking medications the way you should on time you should, evaluating if your home is safe for you regarding your condition, and checking that you eat and drink healthy.
In-home social services may help you find resources in your community that will help you adjust to your health condition. Social, emotional, and psychological counseling is covered as well.
Medicare Coverage for Caregivers by Parts
If a Medicare beneficiary was admitted to the hospital or a skilled nursing facility for three or more consecutive days, they are eligible for Medicare-covered home health care through Part A. Medicare Part A will cover home health services for 100 days as long as a beneficiary is due to receive home health care within 14 days of leaving the hospital or nursing facility.
If a patient was not hospitalized before they get in need of home health care, Medicare Part B will cover their services as long as home services are deemed medically necessary by a licensed provider.
As for Medicare Advantage plans, because they include Part A and Part B coverage bundled into one health plan, home health services will be covered exactly as detailed in both paragraphs above. However, since Medicare Advantage plans are provided by private health insurance companies, certain plan types may require beneficiaries to seek in-network home health service providers.
Being enrolled in the Medicare Part D plan will help beneficiaries cover any prescription drugs needed during their home health stay. But have in mind, since prescription drug plans are offered by private health insurers, certain plans may have limitations on which drugs they cover.
Medicare supplement plans may assist beneficiaries with certain home healthcare costs that are not covered by Medicare. However, since these plans are provided by private health insurance companies, they may require beneficiaries to use providers or prescription drugs that are in-network.