Home health care allows individuals who require it to access medical assistance without leaving their own homes. Medicare covers some forms of home healthcare services; coverage varies by plan and service type. Custodial care does not qualify for Medicare’s home health benefit.
To qualify for home health care services, several requirements must be fulfilled. First and foremost is having an established care plan regularly reviewed by your doctor, who must also certify that you’re homebound – meaning you cannot leave your home for short periods without assistance from someone.
If your doctor determines that you require home health care, they’ll send you a letter outlining all the details of your plan, such as visits dates and times and what services Medicare covers; such as physical therapy, occupational therapy and speech-language pathology services as well as possible medical social services or home health aide services.
Medicare Part B will cover 80% of home health services approved charges; however, you will be required to pay a Medicare Part B deductible before this coverage kicks in. Medigap plans typically provide for coverage of any remaining 20% coinsurance after Medicare pays its share of coverage (80%).
Home health agencies also offer durable medical equipment like wheelchairs or walkers to patients in need. If a doctor determines you require such items, a prescription will be issued through them – you will then work with your insurer to acquire these essential pieces of gear.
If the home health care prescribed by your physician does not fall within Medicare guidelines, you may have to pay for it yourself. Many states offer assistance programs for these expenses. You could also ask your home health agency to help identify items or services not covered by Medicare as well as how much will need to be paid out-of-pocket.
Know that if the home health services you receive aren’t covered by Medicare, Medicaid might offer another solution that could save money in the long run. Medicaid covers services not covered by Medicare as part of their program and could cover their costs as well – saving you both time and money in the process.
Your eligibility for Medicaid depends on your state’s rules, which can differ dramatically. Some states also permit signing up for private health care policies that will help pay for home healthcare needs if necessary.
Medicare Advantage plans also offer home health benefits; according to KFF estimates, 17 percent of these plans offer some sort of in-home support services; however, these benefits typically fall short of meeting Medicare’s home health benefit standards.