Whether Medicare pays for home care depends on why you need it and what kind you’re getting.
Basically, two types of home care are available: in-home care and home health care. These terms are often used somewhat interchangeably, so for the purposes of this article, here’s how we define them:
- In-home care: Help with everyday tasks (such as housekeeping, cooking and running errands) and personal care (including bathing, dressing and feeding).
- Home health care: Skilled medical care (such as physical therapy, IV administration, wound care and chronic-disease management).
What Medicare Pays For
Medicare does not pay for in-home care alone. It will pay for home health care if given by a Medicare certified agency and if you meet certain qualifications. They include:
- Doctor certification that you’re homebound—meaning you shouldn’t leave the home due to your condition, or your condition makes it difficult to leave.
- Doctor certification that you need the following care: (1) physical, speech or occupational therapy, or (2) part-time and intermittent skilled nursing care, which usually means no more than 28 hours a week for less than eight hours a day and fewer than seven days a week. (Your doctor can make limited exceptions if warranted.)
Medicare will pay for help with personal care as well—if you need it for the condition and the agency gives it as part of the home health care. Under certain circumstances, Medicare will also cover 80 percent of the cost of some types of equipment, including a wheelchair, walker, scooter and hospital bed.
You may have heard that Medicare only pays for up to 100 days of nursing home care. That’s true, but the time limitation doesn’t apply to home health care, says Mary St. Pierre, vice president for regulatory affairs at the National Association for Home Care and Hospice. “Home health services may be provided for extended periods of time—even years—if the person continues to meet Medicare qualifying and coverage criteria,” she says.
As you might imagine, Medicare also considers other things besides the aspects listed in this article. In their booklet about home care, the Centers for Medicare and Medicaid Services notes that before services begin, the home health care agency should tell you—both verbally and in writing—how much Medicare will and won’t pay.
Contact Pure Home Care Services at (586) 293-2457 today! If you live in Shelby Township or the surrounding area, we can help you care for your loved ones.