Preparing for Home Health Care as a Medicare Beneficiary

The National Association for Home Care and Hospice estimates that there are currently 12 million people using home health care services. This is becoming a widely accepted and utilized service by many older adults, as it prevents visits to the hospital and residency in nursing facilities.

The good news is, Medicare offers benefits that are of great financial assistance to its beneficiaries.

What is home health care?

As the name implies, home health care is delivered in the comfort of the member’s own home. 

Care is given to those with an illness or injury. It is generally less expensive than care that would be given in a skilled nursing facility (SNF) or hospital. This care is also just as effective and much more convenient for those receiving it.

Individuals may seek home health care for a variety of reasons. These include:

  • Care after surgery or injury
  • Injected medications
  • Health monitoring
  • IV therapy

During their visits, providers of home health care will:

  • Monitor your vitals (blood pressure, temperature, heart rate, etc);
  • Monitor your pain;
  • Ensure the individual is receiving enough food and water;
  • Ensure medications are being taken;
  • Help coordinate care with other providers; and
  • Make sure you are safe

Who is eligible to receive home health care?

To be eligible to receive Part A and B benefits for home health care, you must meet ALL of these requirements:

  • Be under the care of a doctor who also creates and reviews a plan of care
  • A doctor must certify that you are homebound
  • A doctor must agree that you need at least one of the following:
    • Skilled nursing care (intermittent only)
    • Speech, physical, or occupational therapy

What benefits does Medicare provide?

If you meet the eligibility requirements, home health care services are included in both Medicare Part A and Medicare Part B benefits.

Under Original Medicare, your cost will be $0 for home health care services.

If durable medical equipment (DME) is needed, you will pay 20% of the Medicare-approved amount for the equipment.

What doesn’t Medicare cover?

It is important to remember that Medicare does not provide benefits for long-term care. This means that it will not pay for 24-hour care in your home, meal delivery, housekeeping services, or custodial (personal) care.

These all fall under the long-term care definition and have no payable benefits.

Home health care is an excellent option for many older adults, especially because Medicare offers such great benefits for those in need. If this service is something you need, work with a home health care agency to make sure you get the most out of your benefits.