4 Seniors: Does Medicare cover home health care?

4 Seniors: Does Medicare cover home health care?


OKLAHOMA CITY (KFOR) – Home health care services are a valuable Medicare benefit that provides a wide variety of part-time or intermittent in-home skilled nursing care, therapy and other aid to beneficiaries in need, if they meet Medicare’s criteria. Here’s how it works.

In order to secure coverage for home health care, Medicare first requires that you’re homebound. This means that it must be extremely difficult for you to leave home, and you need help doing so either from another person or medical device like a cane, wheelchair, walker or crutches.

You will then need to have a face-to-face meeting with your doctor to get a home health certification confirming that you need skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis.

Your doctor can also request the services of anoccupational therapist and a personal care aide to assist with activities of daily living such as bathing, dressing and using the bathroom. Your doctor must renew and certify your home health plan every 60 days.

You will also need to use a home health agency that is certified by Medicare.

If you meet all of the requirements, Medicare should pay for your in-home health care.

But be aware that Medicare will not pay for personal care aide services (for bathing, dressing, using the bathroom, etc.) alone 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 you have original Medicare, you can locate a Medicare-certified home health agency by calling 800-633-4227. If you have a Medicare Advantage plan, you should contact your 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.

Other Options

If you don’t 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 happen to have long-term care insurance, check to see if it covers in-home care. Or if you have a life insurance policy, see if it can be utilized to pay for care. 

Medicaid: If your income is low, you may qualify for Medicaid (SoonerCare), which offers “home and community-based service” waivers that can pay for in-home care. To investigate this, contact your local Medicaid office.

Also check into PACE, which stands for “Programs of All-Inclusive Care for the Elderly.” PACE provides in-home care, including help with activities of daily living, such as meals, dental and medical care, among other benefits.

Veterans Benefits: If you’re a veteran, the VA also 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 or call 800–827–1000. To look for these and other programs in your area that can help pay for home care, go to PayingForSeniorCare.com and click on “Find Financial Assistance for Care” to access their Eldercare Financial Assistance Locator tool.



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