Does Medicare Cover Home Health Care?
Medicare covers a wide variety of part-time or intermittent in-home health care services to beneficiaries in need, if they meet Medicare's criteria. Here is how it works:
In order for your husband to secure coverage for home health care, Medicare first requires that he be homebound. This means that it must be extremely difficult for him to leave home and that he needs help doing so either from another person or with the assistance of a medical device like a cane, wheelchair, walker or crutches.
He will need to have a face-to-face meeting with his doctor to get a home health certification confirming that he needs skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis.
His doctor can also request the services of an occupational therapist and a personal care aide to assist with activities of daily living such as bathing, dressing and using the bathroom. His doctor must renew and certify his home health plan every 60 days.
Your husband will also need to use a home health agency that is certified by Medicare. If he meets all of the requirements, Medicare should pay for his in-home health care.
Be aware that Medicare will not pay for personal care aide services (for bathing, dressing, using the bathroom, etc.), if he does not need skilled-nursing or skilled-therapy services too. Homemaker services, such as shopping, meal preparation and cleaning are not covered either.
If your husband has original Medicare, you can locate a Medicare-certified home health agency by calling 800-633-4227 or by visiting Medicare.gov/care-compare. If he has a Medicare Advantage plan, you should contact his plan directly and ask which home health agencies work with the plan and are within the plan's network of providers.
For more detailed information on how Medicare covers in-home health, see the "Medicare and Home Health Care" online booklet at Medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf.
If your husband does not qualify for Medicare home health care coverage, there are other coverage options depending on your situation. Here are several that may apply to you:
Insurance: If you have long-term care insurance, check to see if it covers in-home care. If you have a life insurance policy, see if it covers pay for care.
Medicaid: If your income is low, your husband may qualify for Medicaid, which offers different home and community-based services that can pay for in-home care. To investigate this, contact your local Medicaid office.
Also see if Programs of All-Inclusive Care for the Elderly (PACE) is available in your area at Benefits.va.gov/benefits/offices.asp. PACE provides in-home care, including help with activities of daily living, such as meals. PACE also provides dental and medical care, among other benefits.
Veterans Benefits: If your husband is a veteran, the Department of Veterans Affairs (VA) offers some benefits that can help. Two programs to inquire about are "Aid and Attendance or Housebound Allowances" and the "Veteran-Directed Care" program. Both programs provide monthly financial benefits to eligible veterans that can help pay for in-home care. To learn more, contact your regional VA benefit office (see Benefits.va.gov/benefits/offices.asp or call 800–827–1000).
To search for additional programs in your area that can help pay for your husband's home care, use your favorite search engine. You may want to search phrases such as, "paying for senior care", "find financial assistance for in-home care" and "eldercare financial assistance locator."
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living" book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization's official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.