{"id":8478,"date":"2024-11-24T09:41:38","date_gmt":"2024-11-24T09:41:38","guid":{"rendered":"https:\/\/finderica.com\/does-medicare-cover-home-health-care-whos-eligible\/"},"modified":"2024-11-24T09:41:38","modified_gmt":"2024-11-24T09:41:38","slug":"does-medicare-cover-home-health-care-whos-eligible","status":"publish","type":"post","link":"https:\/\/finderica.com\/?p=8478","title":{"rendered":"Does Medicare Cover Home Health Care? Who\u2019s Eligible?"},"content":{"rendered":"\n<div>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"lazyload clicker_number\" style=\"position: absolute; height: 1px; width: 100%\" alt=\"ScoreCard Research\" data-count=\"216.98.0.236,216.98.0.236, 108.162.245.249\" src=\"data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==\"><\/p>\n<p><span style=\"font-weight: 400;\">Home health care in the United States is really expensive. In fact, the cost increased by <\/span><a href=\"https:\/\/thehill.com\/changing-america\/well-being\/longevity\/4586413-eldercare-home-healthcare-largest-ever-price-increase\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">more than 14%<\/span><\/a><span style=\"font-weight: 400;\"> between March 2023 and 2024, with the median cost for a home health aide coming in at $33 per hour.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">That\u2019s $68,640 a year to hire a home health aide to work 40 hours a week.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare \u2014 the federal health insurance program for people ages 65 and older and some younger people with disabilities \u2014 covers certain home health care services.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Home health care is usually less expensive, more convenient and just as effective as getting care in a hospital or skilled nursing facility.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">So does Medicare cover home health care?<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Understanding what Medicare covers \u2014 and what it does not \u2014 can save you and your family lots of time and money.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">We\u2019ll explain Medicare\u2019s definition of home health care, the types of services covered, limitations, eligibility requirements and cost. <\/span><\/p>\n<div class=\"adBorder\" id=\"thepe-609628692\">\n<h3>When Insurance Falls Short\u2026<\/h3>\n<p>Unfortunately, insurance doesn\u2019t cover <em>everything<\/em>. <a href=\"https:\/\/partners.thepennyhoarder.com\/when-money-is-tight-sdyn-prt\/?aff_id=384&amp;aff_sub3=when-money-is-tight-sdyn-prt\/&amp;aff_sub4=191454\" rel=\"false noopener\" target=\"_blank\">These resources<\/a> can help you manage those unexpected expenses.<\/p>\n<\/div>\n<h2>Understanding Medicare\u2019s Definition of Home Health Care<\/h2>\n<p>Medicare defines home health care as skilled nursing care and therapy services provided in a patient\u2019s home to treat an illness or injury. It\u2019s meant to provide support on a part-time basis and doesn\u2019t include around-the-clock custodial care.<\/p>\n<p>Home health care is provided by licensed health care professionals, including registered nurses, physical therapists and occupational therapists.<\/p>\n<p>Medicare covers home health care services for a limited period. It usually follows a hospital stay or after a physician certifies the need for skilled care.<\/p>\n<p>To be eligible for coverage, the care must be intermittent, meaning you don\u2019t require daily attention or 24\/7 supervision. Additionally, the services must be provided by a Medicare-certified home health agency.<\/p>\n<h2>Home Health Care Services Covered by Medicare<\/h2>\n<p>While <a href=\"https:\/\/www.medicare.gov\/coverage\/home-health-services\" target=\"_blank\" rel=\"noopener\">Medicare provides coverage<\/a> for certain home health care services, it doesn\u2019t cover everything.<\/p>\n<p>Here\u2019s what it covers:<\/p>\n<ul>\n<li aria-level=\"1\"><b>Skilled nursing care:<\/b> This includes services like wound care, medication management, intravenous therapy and teaching you and your caregivers about prescription drugs or diabetes care. Services are provided by a registered nurse or licensed practical nurse.<\/li>\n<li aria-level=\"1\"><b>Physical therapy:<\/b> Medicare covers physical therapy services aimed at restoring mobility, improving strength and promoting overall physical well-being. Services are provided by a licensed physical therapist.<\/li>\n<li aria-level=\"1\"><b>Occupational therapy:<\/b> These services focus on helping you regain skills necessary for daily activities, such as bathing, dressing and eating.<\/li>\n<li aria-level=\"1\"><b>Speech-language pathology:<\/b> Speech therapy services are covered for beneficiaries who require assistance with communication or swallowing difficulties.<\/li>\n<li aria-level=\"1\"><b>Medical social services:<\/b> This can include counseling or help finding resources in your community, and it\u2019s provided by a licensed social worker. However, Medicare won\u2019t cover medical social services unless you\u2019re getting other skilled care at the same time.<\/li>\n<\/ul>\n<p>Medicare will cover these services if you receive care less than seven days a week or less than eight hours each day over a period of 21 days (or less) with some exceptions in special circumstances.<\/p>\n<p>If you have dementia and meet the criteria for services, you can get up to 35 hours a week of covered home health care services.<\/p>\n<h2>How Do You Qualify for Medicare Home Health Care?<\/h2>\n<p>To be eligible for Medicare-covered home health care services, the following conditions must be met:<\/p>\n<ul>\n<li aria-level=\"1\">You must be enrolled in Medicare Part A and\/or Part B.<\/li>\n<li aria-level=\"1\">You must be under the care of a doctor who certifies the need for home health care services.<\/li>\n<li aria-level=\"1\">Your doctor must issue a plan of care that details your requirements for one or more of the covered services mentioned earlier. This personalized plan details the type of professional care you need, frequency of services, any necessary medical equipment and expected results from the care.<\/li>\n<li aria-level=\"1\">You must be homebound, meaning leaving the house requires a considerable effort or may pose a risk to your health and well-being.<\/li>\n<li aria-level=\"1\">Your doctor and home health team must review and re-certify your plan of care at least once every 60 days.<\/li>\n<li aria-level=\"1\">You need to have an in-person visit with your doctor either 90 days before starting home health services or within 30 days after services begin.<\/li>\n<li aria-level=\"1\">Home health care services are provided by Medicare-certified agencies. Agency personnel will coordinate and provide the services you need as ordered by your doctor.<\/li>\n<\/ul>\n<p>Once your doctor refers you for services, staff from a home health agency will contact you and set up an appointment to come to your home and assess your condition.<\/p>\n<p>You can learn more about home health care services, including how to pick a home health agency and file an appeal, by checking out Medicare\u2019s <a href=\"https:\/\/www.medicare.gov\/publications\/10969-medicare-and-home-health-care.pdf\" target=\"_blank\" rel=\"noopener\">Home Health Care Handbook<\/a>.<\/p>\n<div class=\"adBorder\" id=\"thepe-544734829\">\n<h3>Heard of These Money-Making Hacks?<\/h3>\n<p>Ready to find out how some folks effortlessly earn the big bucks?<\/p>\n<p>Millions of Americans ignore\u00a0<a href=\"https:\/\/partners.thepennyhoarder.com\/smarten-up-americans-prt\/?aff_id=384&amp;aff_sub3=smarten-up-americans-prt\/&amp;aff_sub4=191931\" rel=\"false noopener\" target=\"_blank\">these easy tips<\/a>\u00a0that could have you padding your wallet in no time.<\/p>\n<\/div>\n<h2>How Much Does Medicare Home Health Cost?<\/h2>\n<p><span style=\"font-weight: 400;\">According to Medicare\u2019s website, people enrolled in Original Medicare who meet the above criteria <\/span><a href=\"https:\/\/www.medicare.gov\/coverage\/home-health-services\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">pay $0<\/span><\/a><span style=\"font-weight: 400;\"> for covered home health care services. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for Medicare-covered medical equipment.<\/span><\/p>\n<p>Medicare Advantage plans, administered by private insurance companies, also cover home health care because they have the same benefits as Original Medicare.<\/p>\n<p>However, Medicare Advantage plans require you to choose health care providers within the plan\u2019s network. Different rules and costs may also apply, so it\u2019s important to contact your specific plan provider to learn more.<\/p>\n<p>Before you start getting services, the home health agency should give you all the details about what Medicare will cover. They should be transparent about any items or services that won\u2019t be covered by Medicare and let you know how much you\u2019ll need to pay for them. They should provide this information both verbally and in writing.<\/p>\n<p>You might come across something called the <a href=\"https:\/\/www.medicare.gov\/basics\/your-medicare-rights\/your-protections\" target=\"_blank\" rel=\"noopener\">Advance Beneficiary Notice of Noncoverage<\/a>, or ABN, before the agency offers you services or supplies. The ABN is a notice that explains why Medicare probably won\u2019t pay for certain services. For example, something may not be covered if the home health agency doesn\u2019t believe it\u2019s medically necessary.<\/p>\n<h3><span style=\"font-weight: 400;\">What it Doesn\u2019t Cover<\/span><\/h3>\n<p>Remember: Medicare does not cover 24\/7 custodial care. That includes assistance with activities of daily living such as bathing, dressing and meal preparation. It doesn\u2019t cover housekeeping, meal delivery and transportation either.<\/p>\n<p>Keep in mind that you may have to foot the bill for any services or supplies Medicare won\u2019t cover. So, it\u2019s essential to understand the costs involved beforehand. Speak with a staff member at the home health agency if you have any questions about your ABN.<\/p>\n<p>And here\u2019s an important tip. If you prefer, you can ask the home health agency to send your claim directly to Medicare if you think the service or supply should be covered. This way, Medicare will review the claim and make a decision about payment.<\/p>\n<p>It\u2019s your right to have the agency bill Medicare, so don\u2019t hesitate to do so.<\/p>\n<h2>Will Medicare Pay for Family Caregivers?<\/h2>\n<p>Medicare\u2019s coverage for home health services is rather narrow. But Medicaid offers additional support in the form of caregiver payment programs.<\/p>\n<p>All 50 states and the District of Columbia offer some kind of program through Medicaid that lets clients choose a family caregiver who is paid with Medicaid funds for providing care to their loved ones at home.<\/p>\n<p><span style=\"font-weight: 400;\">Medicaid is a health insurance program for people with lower incomes. In 2023, about <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility\/seniors-medicare-and-medicaid-enrollees\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">12 million people<\/span><\/a><span style=\"font-weight: 400;\"> were eligible for both Medicare and Medicaid, a situation known as being dual-enrolled. <\/span><\/p>\n<p>Each state has its own Medicaid program, so eligibility criteria and payment structures for family caregivers vary by state. Eligibility is usually based on the beneficiary\u2019s functional and financial needs.<\/p>\n<p>You can find state-specific eligibility criteria <a href=\"https:\/\/www.medicaidplanningassistance.org\/state-specific-medicaid-eligibility\/\" target=\"_blank\" rel=\"noopener\">here<\/a>. If you\u2019re already enrolled in Medicaid, contact your state\u2019s Medicaid office for more information.<\/p>\n<p>To learn more, check out our article on how to become a paid caregiver for a family member.<\/p>\n<div class=\"adBorder\" id=\"thepe-470316811\">\n<h3>Is Your Bank Holding You Back?<\/h3>\n<p>Got $1,000 in checking? These\u00a0<a href=\"https:\/\/partners.thepennyhoarder.com\/1000-checking-account-make-4-moves-prt\/?aff_id=384&amp;aff_sub3=1000-checking-account-make-4-moves-prt\/&amp;aff_sub4=191809\" target=\"_blank\" rel=\"noopener\">smart moves<\/a> could help you reach your next big savings goal. <\/p>\n<\/div>\n<p><i>Rachel Christian is a Certified Educator in Personal Finance and a senior writer at The SS. She focuses on retirement, Medicare, investing and taxes.\u00a0<\/i><\/p>\n<p>        <!-- ACF Financial Disclaimer --><\/p>\n<p>        <!-- End ACF Financial Disclaimer --><\/p>\n<p>        <!-- \n\n<div class=\"single-social-share-bottom text-center\"> --><br \/>\n                    <!-- <\/div>\n\n --><\/p>\n<p>        <!-- Newsletter Signup Form --><\/p>\n<div class=\"newsletter-signup-wrapper-for-digioh\">\n<div class=\"col-xs-12 newsletter-wrap flex-row\">\n<div class=\"container flex-container\">\n<div class=\"col-xs-12 new-newsletter-form\">\n<p class=\"text-subheading\">Ready to stop worrying about money?<\/p>\n<p class=\"text-get-daily\">Get the SS Daily<\/p>\n<p class=\"email-privacy-policy-blurb-white\">\n<\/p><\/div>\n<\/div><\/div>\n<\/p><\/div>\n<p>        <!-- End Newsletter Signup Form --><\/p><\/div>\n<p><script type=\"text\/javascript\" id=\"wp-fcapi-js-before\">\n\/* <![CDATA[ *\/\n!function(f,b,e,v,n,t,s)\n{if(f.fbq)return;n=f.fbq=function(){n.callMethod?\nn.callMethod.apply(n,arguments):n.queue.push(arguments)};\nif(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';\nn.queue=[];t=b.createElement(e);t.async=!0;\nt.src=v;s=b.getElementsByTagName(e)[0];\ns.parentNode.insertBefore(t,s)}(window, document,'script',\n'https:\/\/connect.facebook.net\/en_US\/fbevents.js');\nfbq('init', '263664193816679');\n\/* ]]> *\/\n<\/script><br \/>\n<br \/><a href=\"https:\/\/www.thepennyhoarder.com\/retirement\/medicare-home-health-care\/\" target=\"_blank\" rel=\"noopener\">Source link <\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Home health care in the United States is really expensive. In fact, the cost increased by more than 14% between March 2023 and 2024, with the median cost for a home health aide coming in at $33 per hour. That\u2019s $68,640 a year to hire a home health aide to work 40 hours a week.\u00a0<\/p>\n","protected":false},"author":1,"featured_media":8479,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"footnotes":""},"categories":[348],"tags":[1122,425,1060,326,26,357,847],"class_list":{"0":"post-8478","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-retirement","8":"tag-care","9":"tag-cover","10":"tag-eligible","11":"tag-health","12":"tag-home","13":"tag-medicare","14":"tag-whos"},"_links":{"self":[{"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/posts\/8478","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8478"}],"version-history":[{"count":0,"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/posts\/8478\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=\/wp\/v2\/media\/8479"}],"wp:attachment":[{"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8478"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8478"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/finderica.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8478"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}