Medicare Coverage – Will Medicare pay for my Home Health Care?

What is the difference between Medicare and private home care coverage? As a home care agency, we are asked this question all the time? Along with, “Will my Medicare coverage pay for my home health care”? The answer lies in the services that the patient is requiring.

Typically Medicare coverage is limited. It is usually part-time, intermittent and always short-term. In order to receive Medicare Home Health Care benefits, you need to meet all of the following conditions;

  • Your doctor must certify that you need one or more of the following services: skilled nursing care, physical therapy, speech language pathology services, and/or occupational therapy.
  • Your doctor must also certify that you are homebound.  A doctor will consider you homebound if your condition keeps you from leaving your home without  help of another person. Or if you need the help of a supportive device, (wheelchair, or a walker), Medicare will generally considers that person homebound.
  • The home health care must be provided by a Medicare-approved agency.
  • Once your doctor recommends home care, he must help set up a care plan in cooperation with the home health agency. He must also regularly review the care you receive.

When are home health aide and other home care services covered by Medicare’s home health benefit?

If you have Original Medicare- Part A, will pay 100% of the cost of your covered home health services when home care follows a hospital stay and skilled home care services are needed and prescribed by the hospital or your physician.

Included is an initial evaluation by an RN from a Medicare Home Care Agency, to determine whether you are an eligible candidate for home care. It may also cover a portion of the cost (usually 80%) of any medical supplies that you might use at home.

If your doctor orders home health care and you have not been hospitalized, Medicare will cover home health services. However you will need to have recently seen your doctor for him to prescribe Medicare services.

When are home health aides and other home care services NOT covered by Medicare?

Medicare will not pay for services of a home health aide or certified nursing assistant unless you provide the following:

  • Part-time or long-term personal care by home health aides such as bathing, dressing, eating, using the bathroom, and other activities of daily living.  If this is the only care you need then you will likely pay privately unless you have * long term care insurance.
  • Homemaker services such as cleaning, laundry, shopping and preparing meals.
  • Full-time nursing care by a licensed nurse (LPN/RN)

**Medicare MAY cover a home health aide if you need the services of a physical or occupational therapist 2-3 time a week. This visit is approximately 45 min-1 hr and is solely for the purpose of assisting you with bathing and dressing.

If you or your elderly love one is not ill, but need help with day to day activities, you will have to hire a home health aide privately. Day to day activities include meal prep, bathing, ambulating, dressing, transferring, bathroom activities and feeding.

Private Home Care 

Private home care agencies provide medical and non-medical (also known as custodial care) services. However, Medicare will not cover the cost, unless a medicare agency is used.

The goal of private home care is to help maintain a client’s ability to stay in their home. They also offer respite care to other caregivers, spouses and or family members.

Home Health Aides as well as Certified Nursing Assistants offer assistance so clients remain safe and comfortable in their home.

Platinum Select Nursing is a private Home Care Agency. We pride ourselves on matching the right caregiver to our clients.  We not only meet their needs but we exceed their expectations by establishing genuine relationships. Private Home Care is paid directly by the client and/or long term care insurance. If you have any questions regarding Medicare or Long Term Care insurance,  feel free to call us (561) 998-3211.

We are always available if you know of anyone that would benefit from our services and expertise.