Medicare covers a wide variety of part-time or intermittent in-home health care services to beneficiaries in need, if they meet Medicare’s criteria. Here is how it works.
For a person to secure coverage for home health care, Medicare first requires that they be homebound. This means that it must be extremely difficult for them to leave home, and they need help doing so either from another person or medical device like a cane, wheelchair, walker or crutches.
They will then need to have a face-to-face meeting with their doctor to get a home health certification confirming that they need skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis.
Their 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. Their doctor must renew and certify their home health plan every 60 days.
They will also need to use a home health agency that is certified by Medicare.
If they meet all of the requirements, Medicare should pay for their 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 they do not need skilled-nursing or skilled-therapy services too. Homemaker services, such as shopping, meal preparation and cleaning are not covered either.
If they have original Medicare, they can locate a Medicare-certified home health agency by calling 800-633-4227 or by visiting Medicare.gov/care-compare. If they have a Medicare Advantage plan, they should contact their 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.
If they do not qualify for Medicare home health care coverage, there are other coverage options depending on their situation. Here are several that may apply to you:
If they happen to have long-term care insurance, check to see if it covers in-home care. Or if they have a life insurance policy, see if it can be utilized to pay for care.
If their income is low, they may qualify for Medicaid, which offers different home and community-based services that can pay for in-home care. To investigate this, contact your local Medicaid office.
Also see if PACE – which stands for “Programs of All-Inclusive Care for the Elderly” – is available in your area. PACE provides in-home care, including help with activities of daily living, such as meals, dental and medical care, among other benefits.
If the person is 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 their home care, go to PayingForSeniorCare.com and click on “Find Financial Assistance for Care” to access their Eldercare Financial Assistance Locator tool.
Jim Miller publishes the Savvy Senior, a nationally syndicated column that offers advice for Boomers and Seniors.