If you or a loved one is in need of home health care, it's important to understand what Medicare covers for these types of services and what is excluded. In this blog, you'll learn what home health care entails, what coverage Medicare provides, and where the gaps lie so you can plan accordingly and ensure you or your loved ones are cared for.
What is Home Health Care?
Home health care includes a variety of medical services provided at home to help manage an illness or recover from an injury. It can offer a more affordable and convenient alternative to hospital or skilled nursing facility care while maintaining the same level of effectiveness.
Medicare Coverage for Home Health Care
Original Medicare (Parts A/B) does provide some coverage for home health care services. Coverage is provided to those who qualify by needing part-time or intermittent skilled care and are considered "homebound". A person is considered homebound if they have difficulty leaving home without assistance due to an illness or injury, if it's not recommended for their condition, or if leaving requires significant effort.
As described on Medicare.gov, eligible home healthcare services include:
Medically necessary part-time or intermittent skilled nursing care, such as,
- Wound care for sores or a surgical wound
- Patient and caregiver education
- Intravenous or nutrition therapy
- Injections
- Monitoring serious illness and unstable health status
Source: https://www.medicare.gov/coverage/home-health-services
Coverage Gaps for Home Health Care with Medicare
If you or a loved one is homebound and experiencing the challenges that deem you eligible for home health care, you likely could use support and assistance in other areas not listed above. However, there are several things that Medicare doesn't cover.
Medicare doesn't pay for:
- 24-hour-a-day care at your home
- Home meal delivery
- Homemaking services (like cleaning or shopping) that are unrelated to your care plan
- Custodial or personal care helping you with daily living activities (like bathing, dressing, or using the bathroom), is excluded when it is the only care you need
Source: https://www.medicare.gov/coverage/home-health-services
How to Fill the Gaps Medicare Leaves in Home Health Care
As you can see, there are several things not covered by Medicare that can be beneficial to individuals and seniors, especially when recovering from an illness or surgery. Although Medicare doesn't cover things like meals or custodial care, there are some options and programs available that can help fill these gaps for support and care.
Some options come at a cost, such as adult day care, while others, like Meals on Wheels, may be available on a sliding fee scale. Some Medicare Advantage plans may even offer meal deliveries after a qualifying hospital stay or surgery.
Additionally, for those who qualify or have financial limitations, state programs and organizations exist and offer a variety of support services for seniors, including home care, financial assistance and more.
Related: Does Medicare Cover Long-Term Care?
If you require more support than the Medicare-covered services for home health care, such as extensive, ongoing care, or long-term care (LTC) may be a consideration. There are several ways to cover the costs of long-term care, such as long-term care insurance, a long-term care annuity, and even home health care subscription options.
Don’t hesitate to reach out to our team of licensed agents with any questions or for more information on Medicare coverage or long-term care coverage.
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