Caring for a loved one at home can be emotionally and financially draining. Fortunately, Medicare provides coverage for home health services under certain conditions. Understanding the qualifications and limitations of this benefit helps families access the care they need, while minimizing out-of-pocket costs. Beck, Lenox & Stolzer Estate Planning and Elder Law, LLC, doesn’t work with Medicare in any way, but wants our clients to know how a loved one qualifies for Medicare Home Health benefits.
What Medicare Covers Under Home Health Care
Medicare covers part-time or intermittent skilled nursing care, physical therapy, occupational therapy, speech-language pathology and home health aide services for individuals who are homebound and under the care of a physician. It may also include medical social services and certain medical supplies.
However, coverage does not extend to 24-hour care, meal delivery, homemaker services, or personal care not tied to a skilled medical need.
Who Is Eligible for Medicare Home Health Services?
To qualify, your loved one must meet all the following criteria:
- Be under a doctor’s care and receive regular review of their care plan.
- Require at least one skilled service, such as nursing or therapy.
- Be certified by a doctor as homebound, meaning they cannot leave home without significant effort or support.
- Receive care from a Medicare-certified home health agency.
These requirements must be documented and evaluated before the commencement of services. Recertification is required every 60 days to continue receiving benefits.
The Role of a Physician and Home Health Agency
Medicare requires a face-to-face encounter with a physician within 90 days before or 30 days after the start of home health care. The physician must establish a care plan, which the agency executes. Families should ensure that Medicare approves the agency and that services align with the care plan to maintain eligibility.
Managing Expectations
While Medicare can help relieve the burden of medical care at home, it is not a replacement for long-term personal care. Families should plan for other support services, whether through private insurance, Medicaid, or out-of-pocket resources. An elderly individual may need help with dressing, bathing and meal preparation even when those services aren’t deemed medically necessary.
However, there’s also a legal dimension to paying for these services through benefits like Medicare. Any desired benefits must meet the criteria of being reasonable and necessary for the treatment of illness or injury.
Beck, Lenox & Stolzer Law Firm provides this as helpful information for Medicare recipients. We do not provide information or resources when it comes to Medicare. However, if a loved one is no longer able to remain at home and long-term care is needed in a skilled nursing facility, we can help with information and qualifying for Medicaid. Feel free to schedule a phone consultation with one of our partners, Jayson Lenox or Caroline Daiker Stolzer.
Key Takeaways
- Eligibility depends on a medical need: Your loved one must require skilled services and meet the homebound definition to qualify for home health benefits.
- Physician oversight is required: A doctor must create and regularly review the care plan for Medicare to pay for services.
- Only specific services are covered: Medicare includes nursing and therapy but excludes custodial care like bathing or cooking.
- Approved agencies must deliver care: Home health providers must be Medicare-certified to ensure payment and compliance.
- Families must fill the coverage gap: When non-medical help is needed, additional financial or caregiving support will be necessary.
Reference: AARP (July 13, 2022) “Does Medicare Cover Caregiver Costs and Services?”
