How Does Medicare Pay For Home Health Care?
Home health care refers to medically necessary in-home nursing and rehabilitation services that help you recover after illness or injury, such as physical therapy, occupational therapy, speech-language pathology or hiring a home health aide. Medicare Part A, B and Advantage plans all cover these costs in different ways.
To qualify for home health care under Medicare, typically both Part A and B must be present; additional criteria may include being homebound as well as having an individual care plan from your physician that includes home health services. Medicare-approved home health agencies must conduct a detailed evaluation and regularly reassess your needs to ensure they continue providing coverage. Medicare Part A covers the costs associated with part-time skilled nursing services provided by registered nurses (RN) or licensed practical nurses (LPN), who are overseen by registered nurses. Medicare also covers durable medical equipment and supplies used at home such as wheelchairs and walkers. Medicare Part B covers some in-home physical therapy, occupational therapy and speech-language pathology services as well as supplies and equipment necessary for those services, such as nebulizers, oxygen therapy devices and other health related devices. Medicare Part A and Part B both cover most home health aide services, although you may be responsible for 20% after meeting your deductible. Medicare Advantage plans often provide additional home health-related perks than Original Medicare plans; these may or may not apply to everyone.
Some private insurance and state programs, like Massachusetts’ Community-Based Care Transition Program (CBCP), assist seniors in paying for long-term home health care costs. However, such programs typically impose strict eligibility requirements and only cover limited number of days/hours of home healthcare services per week.
Many Medicare beneficiaries who need home health care opt for long-term care facilities instead of using Medicare’s home health benefits; those wishing to remain at home, however, could find assistance through local long-term care agencies or Medicaid-funded programs like CDPAP.
Seniors requiring ongoing home health care following hospital stays may qualify for Medicare benefits through a new option called the Medicare Home Health Advantage Benefit, administered by private insurers contracted with Medicare to offer home health benefits to beneficiaries; however, this benefit may have greater network restrictions than traditional Medicare Part A and Part B plans.
Medicare’s home health care benefits should not be used as a replacement for long-term care, so professional advice should always be sought when considering your options for long-term care at home. Speak with a certified financial planner about options that might help meet your goals while decreasing costly medical interventions; in addition, speak to social workers and physicians to identify local resources for home healthcare care services.