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How Medicare Covers In-Home Health Care

April 7, 2015

Medicare covers up to 28 hours a week of in-home health care for beneficiaries who meet specific requirements:

  1. To be covered for in-home health care, Medicare requires that you be “homebound.” This does NOT mean that you have to be “bed bound.”  This means that it must be extremely difficult for you to leave your home, and you need help from a device (like a wheelchair or walker), special transportation, or a person to do so. Being homebound could also mean that you have a condition in which leaving the home may cause you harm or is not advised by your physician, or symptoms of your disease process (such as pain, shortness of breath, or confusion) get worse when you leave your home.
  2. Your doctor must approve a Plan of Care confirming that you need skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis. Your doctor can also request the services of an occupational therapist and a home health aide to assist with activities of daily living (ADLs), such as bathing, dressing and using the bathroom. Medicare will not pay for home health aide services alone if your doctor does not require that you also need skilled-nursing or skilled-therapy services. Homemaker services, such as shopping, meal preparation and cleaning are not covered either. Your doctor must renew your Plan of Care once every 60 days.
  3. You will need to use a home health agency that is Medicare certified. THA Group’s Island Health Care and Island Hospice are certified by Medicare to provide home health and hospice services. We also accept Medicare Advantage plans. Read more about our Coverage Information.

Medicare has recently changed their in-home health care policy regarding degenerative diseases. In the past, Medicare would only cover home health care services if the patient were expected to make a full recovery. Now Medicare will pay for in-home physical therapy, nursing care and other services to beneficiaries with chronic conditions like multiple sclerosis, Parkinson’s or Alzheimer’s disease to maintain their condition and prevent deterioration.

For more detailed information on how Medicare covers in-home health care, refer to the Medicare and Home Health Care online booklet.

Other Options

If you don’t qualify for Medicare coverage, there are other coverage options depending on your situation, including:

  • Insurance: If you have long-term care insurance or a life insurance policy, check to see if it covers in-home health care.
  • Medicaid: If your income is low enough, all states offer Medicaid programs that will pay for some forms of in-home health care. To find out, contact your local Medicaid office.
  • Veterans Assistance: Some communities have a Veteran-Directed Home and Community Based Service program, which give veterans a flexible budget to pay for in-home health care. A benefit called “Aid and Attendance” is also available to wartime veterans and their spouses. It helps pay for in-home care, as well as assisted living and nursing home care. To be eligible:
    • You must need assistance with ADLs like bathing, dressing or going to the bathroom.
    • Your annual income must be under $21,466, minus medical and long-term care expenses. If you’re a surviving spouse of a veteran, your income must be below $13,794.
    • Your assets must be less than $80,000, excluding your home and car.
    • To learn more, see va.gov/geriatrics or call 800-827-1000.