What types of home health care will Medicare pay for?

Last time out, we took a look at the four conditions under which Medicare will help pay for  your loved one’s home health care services. We established that the recipient must be considered homebound; needs skilled nursing care or skilled therapy services as often as once every 60 days, or as much as once daily for up to three weeks; is receiving care at a Medicare-certified home health agency; or if your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care.

In this post, we will be taking a look at those types of home health care services Medicare will help pay for, and those it won’t pay for.

First, let’s take a look at those types of care Medicare will pay for:

  • Skilled nursing services and home health services provided for up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
  • Medicare pays in full for skilled nursing care, including services that can only be performed effectively by a licensed nurse. Injections (and teaching patients to self-inject), tube feedings, catheter changes, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan, and wound care are some examples.
  • Medicare will also make full payment if you require the services of a skilled home health aide who provides personal care services like help with bathing, using the toilet, and dressing. If personal care is the only thing you require, you don’t qualify for Medicare home care benefit.
  • Skilled therapy services such as physical, speech and occupational therapy services that can only be performed safely by or supervised by a licensed therapist, and that are necessary for treating your illness or injury.
  • Medicare pays in full for medical social services ordered by your doctor to help with social and emotional concerns related to your illness. This might include counseling or help finding resources in your community.
  • Medicare will also make full payment for medical supplies like wound dressings provided by a Medicare-certified home health agency.

Now, let’s take a look at those types of care Medicare will not cover:

  • If you require 24-hour care at home, Medicare is not likely to cover the full cost of your care.
  • Medicare will also not pay for prescription drugs. To get Medicare drug coverage, you need to enroll in a Medicare Part D plan. There are two options available (stand-alone Medicare private drug plan (PDP), and Medicare Advantage Plan with Part D coverage (MADP).
  • All meals delivered to you at home and homemaker or custodial care services (i.e. cooking, shopping, laundry).
  • Unless custodial care is part of the skilled nursing and/or skilled therapy services you receive from a home health aide or other personal care attendant.

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