Dear Savvy Senior,
How does Medicare cover in-home health care? My husband has a chronic health condition that makes it very difficult for him to leave the house, so I’m wondering if he could qualify for Medicare home health care.
Medicare covers a wide variety of part-time or intermittent in-home health care services to beneficiaries in need, if they meet Medicare’s criteria. Here’s how it works.
In order for your husband to secure coverage for home health care, Medicare first requires that he be homebound. This means that it must be extremely difficult for him to leave home, and he needs help doing so either from another person or medical device like a cane, wheelchair, walker or crutches.
He will then need to have a face-to-face meeting with his doctor to get a home health certification confirming that he needs skilled-nursing care or skilled-therapy services from a physical or speech therapist on a part-time basis.
His doctor can also request the services of anoccupational therapist and a personal care aide to assist with activities of daily living such as bathing, dressing and using the bathroom. His doctor must renew and certify his home health plan every 60 days.
He will also need to use a home health agency that is certified by Medicare.
If he meets all of the requirements, Medicare should pay for his in-home health care.
But be aware that Medicare will not pay for personal care aide services (for bathing, dressing, using the bathroom, etc.) alone if he does not need skilled-nursing or skilled-therapy services too. Homemaker services, such as shopping, meal preparation and cleaning are not covered either.
If your husband has original Medicare, you can locate a Medicare-certified home health agency by calling 800-633-4227 or by visiting Medicare.gov/care-compare. If he has a Medicare Advantage plan, you should contact his plan directly and ask which home health agencies work with the plan and are within the plan’s network of providers.
For more detailed information on how Medicare covers in-home health, see the “Medicare and Home Health Care” online booklet at Medicare.gov/Pubs/pdf/10969-Medicare-and-Home-Health-Care.pdf.
If your husband does not qualify for Medicare home health care coverage, there are other coverage options depending on your situation. Here are several that may apply to you:
Insurance: If you happen to have long-term care insurance, check to see if it covers in-home care. Or if you have a life insurance policy, see if it can be utilized to pay for care.
Medicaid: If your income is low, your husband may qualify for Medicaid, which offers different home and community-based services that can pay for in-home care. To investigate this, contact your local Medicaid office.
Also see if PACE – which stands for “Programs of All-Inclusive Care for the Elderly” – is available in your area (see NPAonline.org). PACE provides in-home care, including help with activities of daily living, such as meals, dental and medical care, among other benefits.
Veterans Benefits: If your husband is a veteran, the VA also offers some benefits that can help. Two programs to inquire about are “Aid and Attendance or Housebound Allowances” and the “Veteran-Directed Care” program. Both programs provide monthly financial benefits to eligible veterans that can help pay for in-home care. To learn more, contact your regional VA benefit office (see Benefits.va.gov/benefits/offices.asp or call 800–827–1000).
To look for these and other programs in your area that can help pay your husband’s home care, go to PayingForSeniorCare.com and click on “Find Financial Assistance for Care” to access their Eldercare Financial Assistance Locator tool.