If you have a medical condition that makes it difficult for you to get out and about, home healthcare could be a more comfortable, cost-effective, and effective option.
Original Medicare (Parts A and B) may sometimes cover medical care provided to you at home if you are homebound. Following an illness or injury, Medicare may pay for some in-home assistance with your daily needs for a limited time.
However, if you need long-term assistance with everyday tasks in your home, you should be aware that Medicare usually does not cover those services.
Is there any coverage for caregivers under Medicare?
The type of treatment you need, the reason you need care, and the amount of time you’ll need it all determine if Medicare will cover in-home caregivers.
Health treatment delivered to your home
If any of the above applies to you and you’re homebound due to an illness or accident, you can use Medicare home health benefits:
- You are only allowed to leave the house for brief outings, such as to the doctor or religious services. One exception: if you go to adult day care, you will always get in-home care.
- The doctor confirms that you need at-home treatment and drafts a plan detailing the services you will need.
- You need professional nursing assistance (less than 8 hours per day and no more than 28 hours per week, for up to 3 weeks).
- Your doctor believes your condition will improve in a fair, or at the very least predictable, time frame.
- •You’ll need a professional physical, occupational, or speech therapist to come up with a plan to help you improve, preserve your current health, or avoid getting worse.
- You need a home health aide to help care for you while you recover.
- The home health agency providing your care is Medicare-approved or certified.
You must see your doctor less than 90 days before or 30 days after you begin accessing home healthcare services to be eligible for in-home treatment.
What types of services will I get at home?
Medicare provides a wide range of programs, some of which can be delivered right to your door. Some programs and the Medicare regulations that apply to them are mentioned below.
If you see a physical therapist in your house, Medicare is likely to provide the following services:
- assessment of your condition
- gait training and exercises to help you recover from surgery, injuries, illnesses, or neurological conditions like stroke
- postoperative wound care
- wound care for injuries, burns, or lesions
If you are treated at home by an occupational therapist, you can continue to receive the following services:
- assistance in developing regular schedules for taking drugs, meal preparation, and personal care.
- showing you how to carry out everyday tasks safely
- assisting you in regaining the ability to work, considering your needs and condition
- assisting you in carrying out your doctor’s orders
- Here are some of the services you can receive if a speech therapist visits you at home:
- education about alternative ways to talk if you can’t understand
- education about different ways to communicate if you’ve lost your hearing
- therapy to help you recover the ability to swallow
- therapy to help you eat and drink as naturally as possible
If a registered nurse or licensed practical nurse visits you at home to provide treatment, they may:
- change your wound dressings
- change your catheter
- inject medications
- administer IV drugs
- teach you how to use your drugs and take care of yourself
Home Health Aides
In contrast, home health aides are more likely to assist you with the following services:
- checking that you’re eating and drinking in a healthy way, such as tracking your vital signs including heart rate, blood pressure, and body temperature
- ensuring that you’re taking your drugs as prescribed
- determining if your home is safe for you, given your needs and condition
In-home social services may also be available to you. If you qualify, you may receive assistance in locating community services to assist you in adjusting to your condition. You may also undergo social, mental, or psychological therapy as a result of your illness.
In-home Custodial Care
Caregivers who assist you with activities of daily life are normally not covered by Medicare unless they are required for a limited time as you recover from an illness or injury.
Food delivery or preparation, shopping, washing, housekeeping or cleaning, assistance bathing and dressing, and assistance using the toilet are all examples of custodial care. If these are the only services you need, Medicare will not pay for a caregiver to provide them in your home.
Medicare has a website to help you locate a home health agency in your region.. If you’ve found a local provider, you can use Medicare’s home health agency checklist to see whether they’ll have the quality of treatment you need.
Your state survey department maintains an up-to-date study on the quality of home healthcare services provided. To find the phone number or email address of the agency in your state, consult Medicare’s resource guide or the survey agency list.
You can only receive treatment from one home health agency at a time if you have Medicare. You will need a new recommendation from your doctor if you plan to switch agencies. You will also need to inform your old agency that you’re switching providers.
If you just need custodial treatment including housekeeping and personal care, Medicare won’t pay for an in-home caregiver. If it’s medically necessary and your doctor certifies that you’re homebound, Medicare can cover some short-term custodial care.
If you’re homebound due to surgery, sickness, or accident, Medicare will cover home health services such as physical therapy, occupational therapy, speech therapy, professional nursing care, and social services.
Your doctor must sign off on the services as medically required, and your home health agency must be Medicare-approved.