At Home Care and Medicare

By Ed Crowe | General Articles | 0 comment | 26 September, 2023 | 0

At Home Care and Medicare: What’s Covered?

If and when seniors have health issues later in life, the best case scenario is often recovering at home. People are most comfortable in their house and it allows for freedoms that hospitals or other institutions often do not allow for, like flexibility of schedule and movement. At home health care can be prohibitively expensive, however, and inaccessible for many people in retirement or on a fixed income. Thankfully, Original Medicare beneficiaries often have at home healthcare benefits. How does at home care and Medicare work?

Both Original Medicare Parts A and B will cover eligible home health and care services. Part A of Original Medicare is hospital insurance and Part B is medical insurance, both of which cover certain services. Both of these parts will cover services for as long as the beneficiary is “homebound.” Homebound is defined as the following criteria:

The beneficiary has trouble leaving their house without help (of a cane, walker, chair, etc.), specialized transportation, or another person assisting them. This can be due to an illness or an injury.
Their condition(s) means that it is not recommended for them to leave their house.
Or they are normally unable to leave their house because of how much effort it takes to do so.

Coordination of Benefits

Typically, a home healthcare service will coordinate the at home care that a doctor or other prescriber determines will be a good fit and orders for the beneficiary. The home healthcare agency must be Medicare certified, and most are. Covered services include the following.

Part time or intermittent skilled nursing care, as needed medically
Physical therapy
Occupational therapy
Speech language pathology services
Home health aide care (only if skilled nursing care is also ordered)
Injectable osteoporosis drugs
Medical supplies for at home use
Durable medical equipment

What Original Medicare does not pay for is a much shorter list, which includes 24-hour care at home, meal deliveries, homemaker services not related to a care plan, or personal care for daily living activities (bathing, dressing, etc.) that are not related to other medical care.