Following hospital stays due to illness or injury, seniors may require home health care in order to recover from illnesses or injuries, as well as assistance with daily tasks like bathing, dressing and eating. Many states provide Medicare-approved home health services and supplies that can assist you with recovery after hospitalization or surgery. Medicare Advantage plans also now offer coverage for home health care that provides “custodial or personal assistance” to assist with daily tasks and mobility. Your level of home health care depends on which Medicare Parts you possess, how long you have been enrolled with this program, and whether a physician or other healthcare professional has certified that it is necessary.
Does Medicare Cover Home Health Care? Yes. Original Medicare typically pays for home health care under Parts A and B if your physician certifies you require it. Medicare Part A typically covers care during the first 100 days following hospitalization or SNF stay while Part B covers home health aide services along with physical therapy, occupational therapy and medical social services; it may also cover durable medical equipment like wheelchairs and walkers as well as bandages or catheters if needed.
Medicare’s home health aide benefits only cover non-medical assistance such as bathing, dressing or eating on an intermittent basis. If a senior requires home health aide services on a more consistent or permanent basis they should explore other care options such as hospice or long-term care facilities.
However, if your physician determines that your condition has improved enough for home health aide services on an intermittent basis to no longer be needed, an agency will send out an Advance Beneficiary Notice of Noncoverage with details on how you may file an appeal against their decision.
Be mindful that home health care coverage only applies if you’re homebound and require skilled nursing or therapy services prescribed by a doctor and provided by an approved home health agency. Medicare requires that you visit an approved doctor at least every 60 days for review of your care plan and to determine whether additional services are necessary or whether some of them should be discontinued. At this stage, the agency must issue you an Advance Beneficiary Notice of Noncoverage (ABN). A copy must also be given to any caregivers involved. As required by Medicare’s “right to know” provision, agencies must give written notification at least two days before your Medicare-covered home health care ends. You can find more details in the Medicare Benefits Booklet for Home Health Care.