How Long Will Medicare Pay for Home Health Care?
January 31, 2024
Medicare is health insurance for seniors, paying for preventative care and significantly offsetting the cost for healthcare, senior living, and home care. However, Medicare can be quite confusing for older adults and their family members. If you find yourself wondering what Medicare covers – and what it doesn’t cover – you aren’t alone. Learning more about coverage can empower you to feel confident as you use services and reach out for support, especially when living at home.
Understanding the extent and duration of Medicare’s coverage for home health care is crucial for anyone who needs these services. This article provides a comprehensive overview, detailing the types of services covered, the duration of coverage, eligibility criteria, and alternatives for long-term care.
Types of Home Care
Home care services are services brought into the senior’s home, and are designed to help an older adult age in place for as long as safely possible. There are two types of home care agencies: medical and non-medical.
Non-medical home care services provide services that do not need to be given by a licensed healthcare practitioner. This means that the caregiver who comes to the home will not necessarily be a nurse or certified nursing assistant, though they will be a trained caregiver who has received training from their agency. Non-medical services can include laundry, housekeeping, transportation, companionship, meal preparation, and assistance with personal care tasks.
Medical home care services, often referred to as home health care, are services that are prescribed by a physician and given by a licensed practitioner.
More About Home Health Services
Home health services encompass a range of medical and therapeutic care provided in the senior’s home by practitioners like nurses or therapists. These services are vital for individuals recovering from illness, injury, or managing chronic health conditions and are prescribed by a physician
Home health services can include things like:
- Skilled Nursing: This involves medical care provided by a registered nurse or licensed practical nurse. It includes wound care, injections, monitoring vital signs, IV therapy, nutrition therapy, and managing medication. In addition, seniors with new conditions or chronic conditions can receive patient and caregiver education, as well as monitoring from a nurse.
- Physical Therapy: Physical therapists help the person improve mobility, balance, and strength through exercises and treatments, often after surgeries or injuries. Therapists come to the senior’s home to work during their sessions, which can be especially helpful as it customizes the experience to ensure the senior is learning how to best navigate their home living space.
- Occupational Therapy: Focused on enabling the person to perform daily activities of daily living, occupational therapists assist in recovering and maintaining skills needed for day-to-day living and working. This can include working to shower or bathe independently, preparing meals, or dressing.
- Speech Therapy: This therapy helps individuals with speech, language, or swallowing disorders to improve their communication abilities and oral motor skills.
- Medical Social Services: These services provide counseling and help in accessing community resources, essential for coping with the social and emotional aspects of illness or disability.
- Home Health Aide Services: Aides assist with basic personal care like bathing, dressing, and grooming, primarily for patients who cannot perform these activities independently. Home health aide services are performed by a certified nursing assistant (CNA) and are personalized based on the senior’s abilities and goals. A nurse will write a care plan stating the type of assistance needed, and the CNA ensures that occurs while in the home.
How Long Will Medicare Cover Home Health Care?
As long as home health services are prescribed by a physician, Medicare will cover some of the costs. Medicare Part A and Part B can cover home health care services, but the duration of coverage is not indefinite. Coverage typically includes:
- Short-term skilled nursing care: Up to 8 hours per day, for a maximum of 21 days. However, exceptions can be made if the doctor certifies that limited additional care is necessary.
- Therapy services: Physical, occupational, and speech therapy services are covered as long as they are deemed reasonable and necessary for the treatment of the patient’s condition.
The key is that the care must be part-time and deemed medically necessary.
Medicare does not cover 24-hour care, meals delivered to your home, and services unrelated to your care plan, like cleaning and laundry. These are services you can get through local senior service agencies (like Meals on Wheels) or non-medical home care agencies, though you will need to pay out-of-pocket or offset the cost through a Medicaid waiver, VA benefit, or long-term care insurance plan.
How to Qualify for Home Health Care
To qualify for home health care under Medicare, the following criteria must be met:
- Doctor’s certification: A doctor must certify that you need intermittent skilled nursing care, physical therapy, speech-language pathology services, or continued occupational therapy.
- Homebound status: The patient must be homebound, meaning it’s extremely difficult for them to leave home due to illness or injury.
- Care plan: The patient must have a care plan regularly reviewed and approved by a doctor. The home health agency will assess the senior and write an initial care plan. They will adjust it based on how the person is meeting their goals, personalizing approaches as they get to know the senior better.
- Medicare-approved agency: The home health agency providing care must be Medicare-certified.
It’s important to note that the person must be under the care of a doctor and receive services under a plan of care established and reviewed regularly by a doctor.
Will Medicare Pay for Long-Term Caregivers?
Medicare typically does not cover long-term home health care. It is designed for short-term, intermittent care, focusing on recovery and rehabilitation rather than ongoing, custodial care.
For those needing long-term caregivers for daily activities like bathing and dressing, Medicare coverage is limited.
What Other Options Can Cover Long-Term Home Health Care?
For long-term home health care needs, there are several options to consider:
- Medicaid: For those who qualify, Medicaid can provide more extensive home health benefits, including long-term care, but eligibility and benefits vary by state.
- Long-term Care Insurance: This type of insurance is specifically designed to cover long-term care services, either at home or in a facility.
- Veterans Benefits: Veterans may have access to additional home health care benefits through the Department of Veterans Affairs.
- State & Community Resources: State and local community organizations often provide services or financial assistance for home health care.
- Personal Savings or Family Support: Many individuals rely on personal or family resources to cover long-term home health care.
Affordable Alternatives for Long-Term Care
Medicare coverage of home health services are designed to be short-term. If you are looking for a more long-term decision, senior living might be an alternative to consider. We encourage you to read our article “How To Pay for a Nursing Home With No Money: Options and Alternatives.”
It covers a number of options to pay for long-term care, including:
We also encourage you to read our “Guide to Aging In Place.” It shares useful information to help seniors stay in their own homes over the long-term, including how to find a certified aging in place specialist and how to get loans or grants to support aging in place.