Does Medicare Pay for Home Health Care Services?

November 25, 2020 by Katie Davis

Medicare pays for home health care services

Home health care is a valuable service that provide necessary support to people who are partially or fully confined in their home. In many cases, home health care services for seniors are covered by traditional Medicare or Medicare Advantage plans.

Home Health Services are Growing in Popularity

The U.S. Centers for Medicare & Medicaid Services (CMS) last month released new Medicare Advantage (MA) figures highlighting a massive expansion of plans offering home-focused supplemental benefits in 2021. Medicare Advantage plans are similar to traditional Medicare plans. But, they are offered through private insurance companies who contract with the Centers for Medicare Services (CMS).

The growing number of Medicare Advantage plans as well as the growth in demand for home care services is a trend driven by research that shows creating a stable home environment for older adults can prevent negative and costly health events.

What Does Traditional Medicare Provide?

Traditional Medicare, Parts A and/or Part B, may cover home health care services provided by a licensed agency. Part A which covers hospitalizations and other in-patient stays, typically covers a certain amount of skilled nursing care provided at home.

This skilled nursing home care benefit includes medically intensive services such as changing wounds, IV medication management and tube feedings. In addition to these services, traditional Medicare will also pay for home health aides to assist you with the activities of daily living (ADL’s) such as bathing, dressing, or going to the bathroom if you need this support because of your illness or injury.

Finally, traditional Medicare also reimburses for the cost of various therapies including occupational, physical and speech therapy provided at home.  And under the Part B benefit, Medicare will cover the cost of various medical supplies that you may need such as walkers or wheelchairs, catheters, and other supplies you may need during the course of your care. Typically, Medicare covers about 80% of the cost of these supplies.

Am I Eligible for Medicare’s Home Health Services Benefit?

Medicare has various rules in place to determine if a person qualifies for reimbursable home health care services. They are:

  • Recipients must be ‘homebound’: Medicare defines behind homebound as being unable to leave your home without “considerable effort or without the aid of another person or a device.”
  • A Doctor (or NP) must deem the service necessary: Medicare home health services initiate with a doctor’s or nurse practitioner’s order. The referring medical professional must assert that you are in need of the services provided before they begin. Of note: the medical professional must have a documented, face-to-face appointment with you no more than 90 days before or 30 days after the start of your home health care services.
  • You must work with a certified agency. For Medicare to cover the cost of your home health services, you must work with an agency who is certified to provide those services.

 Once services begin, beneficiaries must remain under an ongoing plan of care that a doctor reviews regularly. That plan varies per individual but typically includes what services you need, how often you need them, who provides them and what outcomes the doctor expects as a result.

CarePods, like many other private-pay senior care services, provides various household services, meal delivery, 24/hour telehealth monitoring and other valuable oversight. To date, these services are not covered by traditional Medicare although some long-term care insurance policies by cover a portion of your cost.

We are hopeful that as the demand for in-home care grows, traditional Medicare and Medicare Advantage plans will broaden their services to include services like ours.

If you or a loved one is in search of excellent senior care in Charlotte, we’d love to welcome you to our first Pod. Contact us today to learn more!