Updated March 8, 2022 – It’s no secret that home health care isn’t cheap. In 2018, it was estimated that the average cost for non-medical home care was somewhere around $21.00 per hour and could go as high as $27.50 per hour – making it difficult for most seniors to afford. Thus, you may want to try Medicare to help cover out of pocket costs.
But, does Medicare pay for any home health care? While Medicare covers most home health care services for those who qualify, it does not cover everything. The following is a list of benefits and exclusions:
Medicare will pay for most home health care, including:
- Durable medical equipment
- Medical supplies
- Medical social services
- Skilled therapy services
- Skilled nursing services
That said, Medicare will not cover:
- Personal care
- Occupational therapy
- Custodial care and 24-hour a day care
- Meals that are delivered to your home
- Homemaking services like laundry, vacuuming, etc.
In this article, we will clearly explain the instances in which a senior may require home health care. We’ll also talk about the coverage you can get, the length of coverage, the differences between Medicare Part A and Part B, and more. Keep reading!
What Does Medicare Cover For Home Health Visits?
In the intro, we talked briefly about the services that Medicare would cover for home health visits. Let’s expand on these now, as well as the list of what’s not covered.
We’ll start with what should get covered by Medicare – in most cases:
Durable Medical Equipment (DME)
Durable medical equipment (DME) is defined by Medicare as:
- used for a medical reason
- will be used in your home
- is not something that is usually used by someone who is not injured or sick
- has a general lifetime of at least three years
Durable medical equipment would be something along the lines of bathtub benches for showering, walkers, wheelchairs, canes, oxygen equipment, and the like do get paid for by Medicare, but rarely in full.
Instead, after meeting your annual deductible, you will have to pay 20 percent of the coinsurance rate for each piece of equipment you need.
Also keep in mind that you must have a written order from a Medicare-enrolled doctor or the claim for durable medical equipment will not be covered.
And, you can’t just go into any supplier to get the DME – the equipment must come from a Medicare-enrolled supplier who is “participating”, meaning they will accept assignment for the cost of the equipment.
Unlike durable medical equipment, Medicare generally pays for the entire cost of most medical supplies.
From catheters to thermometers, bandaging, bedding, and everything in between, you shouldn’t have to cover for these items out of your own pocket.
Medical Social Services
If you need guidance on which resources are available for the elderly or if you want therapy for a senior, these services fit under the umbrella of medical social services. Medicare will pay for these so you don’t have to.
Skilled Therapy Services
Occupational therapy, speech therapy, and physical therapy by a licensed therapist all count as skilled therapy services.
More than likely, Medicare will cover the costs under your insurance plan so a senior can get the therapy they need. The only exception is occupational therapy, as we said in the intro. In some instances, it’s covered, but not in most.
Coverage depends on whether the senior also needs further home health care. Otherwise, you will have to shell out the money yourself for occupational therapy.
Skilled Nursing Services
With skilled nursing services, a nurse can take care of doing medical evaluations, create and adjust a care plan, care for a wound and change out a catheter. They can also feed the senior via a tube if they have one inserted and administer injections as needed.
Most skilled nursing services should be included under the scope of your insurance plan so you don’t have to pay for them.
If you get services from a home health agency in Florida, Illinois, Massachusetts, Michigan, or Texas, you may be affected by a Medicare demonstration program. Under this demonstration, your home health agency, or you, may submit a request for pre-claim review of coverage for home health services to Medicare. This helps you and the home health agency know earlier in the process if Medicare is likely to cover the services. Medicare will review the information and cover the services if the services are medically necessary and meet Medicare requirements.
Your Medicare home health services benefits aren’t changing and your access to home health services shouldn’t be delayed by the pre-claim review process. For more information, call us at 1-800-MEDICARE.Medicare website
Medicare does not cover things like long term care, routine foot care, dental care and dentures, eye exams for prescribing glasses, or hearing aides, even if they are necessary for someone who is receiving home health care.
When Is Home Health Care Needed?
Home health care encompasses a variety of services for seniors. It’s an alternative to sending an elderly loved one to a nursing home facility or getting them care in a hospital. Home health care often costs less compared to those services, as well.
If you have a senior loved one who is experiencing the following, you might want to consider getting them home health care:
- Gradual physical or mental decline
- Becoming more dependent on others for care
- An illness, whether from a short-term sickness or a long-term condition
- An injury, be that a recent one or a nagging injury that causes chronic pain
Who Qualifies For Home Health Care Services?
Not everyone who applies for home health care services will necessarily get them, as older adults must be qualified for this form of Medicare.
According to the Medicare website, one must meet the following parameters for insurance coverage:
- The senior cannot require more than intermittent nursing care or that which is classified as beyond part-time care.
- They’re home bound and have been declared such by a doctor. Medicare Interactive.org defines being home bound as a person having great trouble leaving the house, enough so that they rarely do. They may also require a wheelchair, a walker, or crutches to get around.
- On Medicare’s website, they do mention that the senior can go out at times, such as for church or religious services as well as for doctor’s appointments or other care.
- The person also requires the following:
- A physical therapist for therapy to alleviate pain.
- A maintenance program for pain or a condition, often created by the therapist.
- A good recovery prognosis.
- The senior must be consistently seeing a doctor, who administers a treatment plan or care services.
How Long Does Medicare Pay For Home Health Care?
You’ve just found out that Medicare will pay for many of the home health care services your senior needs. That’s great news! The question now becomes, how long will that care last?
If you’re looking for care for your senior that is provided 24/7 around the clock, you’ll have to consider a nursing home or another option. Medicare doesn’t provide coverage for this type of care.
Instead, they emphasize that the care that is required must be “intermittent.” In other words, the senior either needs “Fewer than 7 days of care each week or need daily care for less than 8 hours each day for up to 21 days.”
Additionally, Medicare also notes that it may extend the three week limit in exceptional circumstances if your doctor can predict when your need for daily skilled nursing care will end.
Is Home Health Covered Under Part A Or Part B Medicare?
Actually, it turns out that both Medicare Parts A and Part B cover certain aspects of home health care.
As you probably know, original Medicare is broken down into several parts. Once your insurance approves a senior for Medicare, they’ll get coverage under either Part A or Part B.
You may have heard of these terms in passing, but now that they apply to someone you love, you’ll want to learn about them as much as you can.
What Is Part A And Part B Medicare?
With some exceptions, Medicare Part A is hospital insurance and it covers services such as:
- Hospice care
- Home health care
- Non-custodial, non-long term care in a skilled nursing facility
- Inpatient hospital care
Medicare Part A usually lacks a monthly premium for most people who are age 65:
- Those who get it premium-free are people who get Social Security retirement benefits or retirement benefits from the Railroad Benefit Board.
- You also won’t pay a premium if you are 65 and eligible for Social Security or Railroad benefits but have delayed filing for them because you’re letting the benefits build up (increase) or if you or your spouse had Medicare-covered government employment.
- Keep in mind that some people under the age of 65 can also get free Medicare Part A if they meet certain requirements.
If a senior does have to pay a premium for Medicare, the premium they pay is based off the amount of years the senior worked and paid their taxes.
For example, those who worked and paid Medicare taxes for between 30-39 quarters (a little less than a decade of work) would, as of 2019, be charged $240 as a premium per month. If a senior worked and paid Medicare taxes for under 30 quarters, they would pay a monthly premium of $437.
Part B Medicare is more like traditional medical insurance. Part B Medicare pays for many things that could be part of a home health care setting, including:
- Durable medical equipment
- Medical supplies
- Physical therapy
- Doctor’s appointments
- Ambulance services
Part B also covers other medical services that may not fall under home health care, such as:
- Self-management therapy
- Second opinions before surgery
- Outpatient counseling and therapy
- Most shots
- Preventive services
Medicare Part B does have a premium. As of 2019, it is $135.50 per month for most people, however this premium could be higher depending on your earnings.
For example, if the person’s modified adjusted gross income is higher than $85,000 for a single person or $170,000 for joint filers, they will also have to pay an additional monthly Income Related Monthly Adjustment Amount (IRMAA). This would increase their premium to $189.60 per month.
To determine the Part B premium amount, Medicare reviews the last two years of the senior’s income tax returns.
Medicare Part B has rules and exclusions that come into play when receiving medical care. Also, Medicare relies on an agreement known as Medicare assignment that you must follow.
Plus, despite paying a premium for coverage, seniors will usually also have to pay a certain portion of the Part B bills (an exception is for preventive services rendered by a medical provider who accepts Medicare assignments).
There is an annual deductible of $185 that they will likely have to meet, as well as an amount they will have to pay per service. Medicare agrees to this amount, of which the senior will pay a copay of 20 percent.
Can I Get Paid For Taking Care Of My Elderly Parent?
As your mother or father has gotten older, you’ve stepped up to the plate to take care of them. You may or may not have quit your job. Maybe now they live with you full-time so you can offer as much care as you can reasonably provide.
If you’re curious whether you can get any reimbursement or compensation for the money and time you put forth for your elderly parent’s care, be assured that you usually can under Medicaid. *NOTE: Keep in mind that Medicare and Medicaid aren’t the same thing.
Regular Medicaid, which is the Medicaid program that is governed by each state, generally covers Adult Foster Care as a Personal Care benefit, as long as the senior meets the Medicaid eligibility requirements.
Under the Personal Care benefit, a “personal care attendant” can provide services for the senior in the elder’s own home or in the adult child’s home.
Personal care services would be something like helping the senior bathe or dress, helping them eat, or helping them transfer from bed to a chair or wheelchair.
Depending on the state in which you live, Medicaid has the following options where you could possibly earn payment in some form:
- Adult Foster Care: With adult foster care, Medicaid pays adult children to enter the caregiving role for their parents. This is only available in a few states. If you live in one of them, you can get paid for the services you provide for your parent, as well as receive coverage for prescriptions, medical care, and other services for the senior parent(s).
- Medicaid Caregiver Exemption: The Child Caregiver Exemption or Caregiver Exemption prevents Estate Recovery from taking the parent’s home in their old age. Instead, the adult child could get the home. That’s their form of compensation in this case.
- Medicaid Personal Care Services: Medicaid State Plans or Medicaid Personal Care Services offer benefits to adult children for taking care of their senior parents. Medicaid chooses the hourly rate of payment.
- HCBS Waivers and 1915(c) Waivers: Several waivers under Home and Community Based Services or HCBS will cover the cost of support services and care for seniors who aren’t placed in nursing homes. Whether the adult child needs coverage for chores or personal care, they can get it under these waivers. They themselves aren’t paid directly.
Depending on the state, Medicaid will also cover such things as:
- Certain transportation expenses you provide for the senior
- The cost of preparing and serving a meal, as well as clean up. It will not cover the cost of the elder’s food.
Medicaid will not cover room and board costs for a senior who is in Adult Day Care, so if your elderly parent lives with you, you could not get paid for the costs of things like electricity or water that the senior may use.
Adult children helping older parents should also look into these options in which they could get some money:
- Credits and tax deductions
- Paid Family Leave
- Long-term care insurance
- Life insurance benefits from cashing in Whole Life policies, in full or in part. Additionally, some life insurance policies will let the policy holder “borrow” against the amount of the policy.
- Loans, such as personal loans or home equity loans
- Non-Medicaid programs, which vary on a state by state basis
- Veteran’s Aid & Attendance and Housebound Pensions, as applicable
- Veteran’s Directed Home and Community Based Services, as applicable
- Reverse mortgages, however, they require that the senior live in their own home and would likely not be sensible to take unless the elder would be in adult foster care for more than two years (which is usually not likely).
Medicare can pay for a range of home health care services, including equipment, physical therapy, supplies, and nursing and doctor’s care. That said, occupational therapy, homemaker services, and personal care get no coverage.
If you’re caring for a senior parent or loved one and you’re looking into Medicare for the first time, we hope this article provides you the information and guidance you need. Good luck!