Medicare and Home Healthcare

What is home healthcare?

Home healthcare is a term used to describe a wide variety of healthcare services and treatments that may be administered in the comfort of your own home. 

Usually, these treatments and services are given in order to help you recover from illness or injury. When compared to healthcare services received in a hospital setting or doctor’s office, home healthcare is usually less expensive, more convenient, and every bit as effective.

Some examples of home healthcare treatments and services include:

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• IV or nutrition therapy
• Injections (such as insulin)
• Monitoring serious illness or unstable health status

Doctor’s orders are required to begin home healthcare. Once your doctor refers you for home health services, a home health agency will schedule an appointment to visit your home and talk to you about your health and wellness needs.

Why might someone need Medicare home health care?

As we age, we become more prone to certain illnesses and our bodies naturally become less physically durable and more prone to injury or disability. As a result, we may eventually have a need for regularly-scheduled skilled nursing care, as well as other skilled care services such as physical and occupational therapy, speech-language therapy, and medical social services.

Recently, the need for home healthcare has increased for a variety of reasons. For one, medical science and technology has grown exponentially since the start of the 21st century, with increased rapid growth even in the past 10 years or so. 

This means that many treatments that may once have only been possible in a hospital setting can now be performed at home. In addition, home healthcare has recently become more and more affordable and more convenient for millions of people nationwide, especially seniors.

The goal of short-term home healthcare has typically been to provide effective treatment for injury or illness recovery in a familiar and comfortable environment. Not only can home healthcare help you get better, but it can also help you more quickly regain your independence and become self-sufficient more quickly.

The goal of long-term home healthcare (for chronically ill or disabled individuals) is to help patients maintain a high-level of health while learning to live with your condition in the most positive way possible.

Whether you require short-term or long-term home healthcare services, home healthcare staff will typically assist you with the following needs:

• Eating and drinking regularly
• Checking your vitals, including blood pressure, temperature, heart rate, and breathing
• Taking your medications properly and administering treatments effectively
• Pain management
• Safety and wellness management
• Educating you on your condition and care
• Communicating regularly to effectively coordinate your care with you and anyone else who handles your care

Home healthcare staff will also stay in regular communication with your doctor regarding your care, helping to keep them updated on your condition and progress. It is incredibly important that your home healthcare staff see you as often as your doctor orders.

How does Medicare work with home health care?

You may be pleased to learn that if you currently a Medicare recipient, you can get coverage for certain home healthcare benefits, provided you meet all of the following criteria:

• Your doctor has decided that you require home healthcare services and has put a plan in place for your home healthcare treatment.
• The home healthcare services you require fall into at least one of the following categories: skilled nursing care, physical therapy, occupational therapy, speech-language therapy.
• You are considered to be homebound or otherwise unable to leave your home without assistance.
• The home health agency from which you receive care is formally Medicare-certified.

So what home healthcare services does Medicare cover?

Provided you meet all of the aforementioned criteria for receiving home healthcare, Medicare will cover the following:

• Skilled nursing care conducted on a part-time or intermittent basis – Skilled nursing care refers to services that can only be performed safely and correctly by a licensed nurse, including registered nurses (RNs) or licensed practical nurses (LPNs).
• Home health aide services provided on a part-time or intermittent basis – This typically refers to custodial services such as bathing, using the toilet, and dressing.  Keep in mind that a home health aide does not have a nursing license, and therefore only provides services that are intended to provide additional support to the nurse. Remember that Medicare does not cover these services unless you already receive skilled nursing care.
• Physical therapy – This includes exercises and activities intended to help you regain movement, strengthen a given body area, and perform daily activities (like getting in and out of the tub).
• Speech-language therapy – This refers to pathology services such as exercises and activities that are intended to help you regain and strengthen your ability to speak and communicate effectively.
• Occupational therapy – This type of therapy is intended to retrain your brain and body to do usual daily activities all by yourself. For example, you may learn new ways to feed, dress, and groom yourself.
• Medical social services – These services are intended to help you deal with social and emotional concerns related to your illness or disability. This may include counseling or resource outreach assistance.
• Certain medical supplies – Medicare may cover certain medical supplies such as wound dressings and medically-necessary durable medical equipment (wheelchairs, walkers, etc.). Please note that Original Medicare does not cover prescription drugs or biologicals in this context.

What won’t Medicare pay for when it comes to home healthcare?

Under current Medicare-approved home healthcare standards, Original Medicare will not cover:

• 24-hour a day home healthcare
• Prescription drugs
• Meals delivered to your home
• Homemaker services such as shopping, cleaning, and laundry needs
• Personal care like bathing, using the toilet, or help getting dressed when this is the only care you require

Is there anything I can do to receive more coverage for Medicare home healthcare?

While Original Medicare is often limited in terms of what services and treatments are and are not covered, it may still be possible to extend your personal Medicare plan to include additional coverage for these services, as well as additional healthcare needs such as vision, hearing, and dental care.

This coverage can be provided under Medicare Part C, also known as Medicare Advantage. Medicare Advantage plans are sold by private insurance companies, which means that their availability, exact pricing, and exact benefits may vary. Nevertheless, all Medicare Advantage plans are required by law to at least provide the same coverage as Traditional Medicare plans.

If you are interested in the possibility of getting covered for more comprehensive home healthcare needs under Medicare Advantage, the licensed insurance agents at MedicareInsurance.com can help you research and explore options in your area.