Many aging adults may need some form of in-home care later on in life. Since Medicare is a health insurance lifeline for many seniors in the U.S., many may wonder: Does Medicare cover home healthcare costs? With all healthcare costs on the rise, it’s important to understand what home healthcare costs Medicare does and doesn’t cover. To better understand your Medicare home healthcare coverage, here’s what you need to know.
If you need extra assistance planning for senior care, consider enlisting the help of a trusted financial advisor.
What Is Home Healthcare?
Home healthcare is care provided in a patient’s home. When someone is injured or suffers from a health issue, he may need additional care to recover but may not be so unwell that he needs to be in the hospital. This is where home health care comes in.
Home healthcare is typically less expensive than long-term care or living in a skilled nursing facility during recovery. In addition to being cost-effective, home health care is also typically more convenient for patients. People who have suffered an injury or illness are often eager to get home and attempt to return to their normal routine. Home healthcare is effective in transitioning patients back to their homes while still getting them the assistance and health care they need to recover.
Who Is Eligible?
Medicare is available to people over age 65. For people with some disabilities or diseases, eligibility might come at a younger age. Additionally, Medicare recipients must be U.S. citizens or permanent legal residents for at least five years. You may also qualify if you or your spouse has worked long enough to be eligible for Social Security benefits. Lastly, you can qualify if you or your spouse is a government employee or retiree who has not paid into Social Security but has paid Medicare payroll taxes.
To qualify for home health coverage, you must meet all the following conditions:
- You must be homebound. You must be unable to leave your home without considerable effort or assistance. This assistance may include another person or the help of a walker or wheelchair.
- A doctor certifies you. A doctor or medical professional such as a nurse practitioner must certify that you’re in need of occupational therapy, physical therapy, skilled nursing care, or speech-language therapy.
- That certification came from a documented encounter. A doctor must have seen you face-to-face no more than 90 days before the start of your care and no more than 30 days after the start of your home healthcare.
- You are under a care plan with a doctor. If a doctor establishes a care plan that he reviews regularly and it includes the services you need and how often, you can qualify. It must also include the supplies that are required.
- You receive approval from Medicare. The final step is to ensure that Medicare approves the home health agency that you have chosen for your care.
What Does Medicare Cover?
Medicare Parts A & B cover a wide range of home health services.
Skilled nursing care
In-home nurses can help change bandages, feed you if you are intubated and inject necessary medications. Some skilled nursing services are available around the clock, and others are only needed on a part-time basis. In-home nursing and personal care cannot exceed 28 hours per week to be covered by Medicare.
Home health aides
Health aides can help with personal activities such as bathing, eating, and going to the bathroom if you need extra assistance due to injury or illness. Medicare covers these services if you are also getting skilled nursing or therapy. Therapists, including occupational, physical and speech therapists, might be included under home healthcare. They will be able to help you recover from injuries or help you maintain your health to avoid future illness.
If you need catheters, wound dressings or other supplies related to your condition, then your home health care agency should provide them. This could also include wheelchairs and walkers, but Medicare does not pay the full cost of these supplies. You are typically responsible for 20% of the total cost
Medical social services
If you need counseling or emotional support related to your illness or injury, home healthcare can connect you with the necessary community resources.
What Doesn’t Medicare Cover?
Although Medicare covers many costs of home healthcare, there are a few things that you should anticipate paying for out of pocket:
- Round-the-clock home care. This special type of care can range anywhere from $200 to $300 per day.
- Meal delivery to your home. Depending on your dietary needs, this service can cost around $12 per meal.
- Household assistance. Home assistance may include grocery shopping, housekeeping and similar chores. Pricing for these services may depend on your needs.
- Custodial or personal care when it’s the only home care you need. This means that if you only need occupational therapy but not other assistance, you do not qualify for home healthcare coverage. However, if you receive occupational therapy, you will only need to pay 20% of the Medicare-approved amount out-of-pocket.
The Bottom Line
If you meet all the requirements for Medicare to cover your home health care, then Medicare should pay for all your covered services and supplies. To answer any further questions about Medicare and what your plan covers, the Medicare.gov website has a host of resources. On the website, you can check coverage details and find service providers in your area. If you are concerned about how to cover your healthcare costs in the future, you should make planning and saving for retirement a priority.
Tips for Managing Your Healthcare Costs
- Just as you would consult a healthcare professional to assess your well being, be sure to consult a financial professional to asses your fiscal well being. If you don’t have a financial advisor yet, finding one doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
- Medicare for All is a major issue in the 2020 presidential election. Find out all you can about what it would mean for your and your healthcare expenses as you strategize alternatives to lower your costs.
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