Medicare’s home health care coverage is a common query amongst senior adults looking for skilled nursing facilities, in-home treatments and they want to know that How Long Will Medicare Pay for Home Health Care. Although Medicare is an excellent choice for in-home treatments, it does come with certain limitations.
Medicare pays for home health care if the applicant requires skilled services for under 8 hours per day, fewer than 7 days a week, for a maximum duration of 3 weeks.
You can extend this service for more than 3 weeks after your doctor foresees the duration of future services needed. For example, after a senior has had Medicare home health care service for three weeks, their condition is evaluated by a licensed healthcare professional.
If the doctor believes that they don’t need to continue their skilled nursing facility, Medicare will not pay for home health care beyond three weeks.
These home healthcare services are not only cost-efficient but also provide you with more convenience. More importantly, they’re equally effective as getting your treatment done at the hospital or a skilled nursing facility.
The primary goal of home health care services is to provide thorough treatment for prolonged illnesses or an injury. These services aim to help you regain independence and recover within the comfort of your home.
Understanding Home Health Care Services
Healthcare facilities such as physical therapy and skilled nursing care provide senior adults with assistance and support.
Some home healthcare services also provide help with everyday tasks. These cost-efficient in-home services become essential when you want to reduce your commute to the nearest hospital.
Fortunately, Medicare often pays for home health care. But before you choose Medicare to cover home health care, it’s crucial to understand the eligibility criteria and what’s included in your Medicare home health care plans.
Let us look into some of your important queries before applying for Medicare home health care services.
Does Medicare Cover Home Health Care?
In 2023, Medicare helped 3 million individuals with their home care services. The Medicare program spends approximately $16.9 billion for these services offered through 11,474 skilled home healthcare agencies.
Senior adults who cannot leave their homes due to limitations are eligible for Medicare home health care. Those who require intermittent skilled care for an injury or illness can also apply for the program without a preceding hospital stay.
Moreover, Medicare benefits the enrollees and provides them with extra ease, as its home health care programs do not feature copayments, coinsurance, or deductibles. These aspects make Medicare home health care an excellent coverage choice.
Medicare coverage for home health care is provided under Medicare Part A and Part B insurance. However, you can get additional coverage for prescription drugs by applying for Medicare Part D.
Once you enroll in Medicare home health care, these skilled services are provided by Medicare-certified agencies.
How Does Medicare Pay for Home Health Care?
If a patient’s condition restricts them from leaving their homes and they find it challenging to carry out everyday tasks, Medicare covers part time and intermittent skilled nursing care, occupational therapy, speech language pathology service, social service, and physical therapy.
A qualified healthcare provider certifies the need for any of these services and curates a care plan. Since these services are covered by Medicare Part B, Medicare beneficiaries don’t have to pay.
When eligible individuals require home health care with medical equipment such as a wheelchair or a walker, they pay up to 20% of the cost according to Medicare’s criteria after they have paid for Medicare Part B deductibles.
Thus, if you pay for part B deductibles, Medicare helps cover the remaining cost of your medical equipment.
However, home health agencies need to estimate the average Medicare coverage and out-of-pocket costs before you apply for this program.
Moreover, Medicare covers home health care services for 30 days of care. The payment for your monthly care is decided every 30 days, depending on your condition and the level of care required.
An Insight Into Home Health Agency
Receiving treatment from Medicare-certified home health agencies lowers your healthcare bills. These agencies are only paid by Medicare.
They accept a specific amount approved by Medicare for their services. Thus, you don’t have to pay your home healthcare providers an out-of-pocket cost.
Essentially, if you have Medicare Part B, it significantly lowers the cost of your medical equipment and other necessities.
But before you start receiving your home health care services, your home health agency will guide you about the specific amount Medicare will pay for your treatments.
Plus, the agency also tells you about additional costs and if you have to pay for any other services.
What’s Covered in Home Health Care?
If you fulfill the eligibility criteria for receiving in-home treatment, Medicare covers a range of services deemed necessary for your care. Medicare home health care coverage includes the following.
- Occupational therapy
- Physical therapy
- Intermittent skilled nursing
- Home health aide services
- Speech pathology
- Medical supplies
- Medical social services
How Do You Qualify for Home Health Care Under Medicare?
There are specific eligibility criteria for Medicare home health care services. You or your loved ones must meet these requirements to qualify.
- Doctors Supervision
To qualify for Medicare coverage for home health care, a patient must be under a doctor’s supervision and follow a specific care plan that is regularly reviewed by a physician.
The patient’s need for home health care must be approved by a certified doctor and other licensed professionals who have been in contact with the patient and can vouch for specific time frames for when the care is needed.
- Must Require Specific In-Home Services
Services such as skilled nursing facilities, occupational therapy, intermittent care, or speech-language pathology services must be deemed absolutely necessary for the patient by a licensed healthcare provider.
- Must Be Home-bound
Another important requirement for Medicare home health care plans is that the patient must be home-bound. This means that they require assistance in leaving their home at all times or they’re unable to leave their home due to an illness or injury.
Limitations of Medicare Coverage for Home Health Care
Here is a summary of the limitations of Medicare coverage for home health care.
| Limitations | Details |
|---|---|
| Coverage Duration | Not more than 30 days, with a recertification by a doctor every 60 days. |
| Supervision Required | Regular care must be under a doctor’s supervision. |
| Physician Approval | A certified doctor must approve the need for home health care. |
| Specific Time Frames | Care needs must be documented within a certain time frame. |
| Intermittent Care | Medicare covers part-time or intermittent care, not full-time. |
| Homebound Status | Patients must be homebound. |
Finding a Medicare-Certified Home Health Agency With Silveredge
When home health care is deemed necessary for a patient by an authorized doctor, Medicare provides essential assistance for in-home care.
Patients can select a Medicare-certified home health agency to receive Medicare coverage benefits. These agencies evaluate the federal standards for receiving healthcare services.
If you or your loved ones are looking for quality care within the comfort of your home, Medicare can provide essential support and coverage through the agencies that serve your area.
Silveredge can help connect you with a certified Medicare home health agency near you to ensure you receive health benefits within the comfort of your home!
