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Does Medicare cover home health care?

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[x_blockquote cite=”Musa (Cary, NC)” type=”left”]Dear Marci,
My father might need care in his home. What type of home health care does Medicare cover?[/x_blockquote]

Dear Musa,

Original Medicare will cover certain home health care services through the home health benefit if you father meets a few requirements. Home health care services must be ordered by a doctor and coordinated through a home health care agency.

Medicare covers the following types of care:

  • Skilled nursing services. Medicare pays in full for part-time skilled nursing care, which is care that can only be performed safely by a licensed nurse. Part-time means the care is provided up to seven days a week for no more than eight hours per day and 28 hours per week.
  • Skilled therapy services. This includes physical, speech, and occupational therapy provided by a licensed therapist. Note that occupational therapy is only covered if your father also needs physical or speech therapy. Your father will not qualify for the home health benefit if he only has a need for occupational therapy.
  • Home health care services provided by a home health aide if your father also needs skilled care. Home health aides provide personal care such as help using the bathroom. If your father only needs personal care, he will not qualify for the home health care benefit.

Under the home health care benefit, Medicare also covers medical social services such as counseling, medical supplies such as catheters, and durable medical equipment such as a wheelchair or a walker.

It is important to note that although the home health benefit covers the services of a home health aide when skilled care is also needed, it does not cover 24-hour care. The home health benefit also does not pay for meals delivered to your home or homemaker services such as grocery shopping.

Medicare covers home health care if:

  • Your father’s doctor has certified that he is homebound, meaning it is very difficult for him to leave the home, and he needs help doing so.
  • Your father needs skilled nursing services on a part-time basis and/or skilled therapy.
  • Your father has a face-to-face meeting with a doctor within the 90 days before beginning to receive home health care, or within 30 days after the first day he receives care. His doctor must sign a certification of home health care and re-certify it every 60 days.
  • Your father receives home health care from a Medicare-certified home health agency.

Your father should speak with his doctor to learn more about this benefit, and the types of care your father thinks he needs. Your or your father’s doctors can also find Medicare-certified home health agencies by going to www.medicare.gov/homehealthcompare.

– Marci

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