There’s no place like home. That’s why home healthcare can provide support that empowers people to recover and stay healthy without stepping outside the comfort of their own door.
When the responsibility of caring for an aging relative falls on you, you don’t have to do it alone. Home healthcare can help families find additional, personalized care for their loved ones, offering peace of mind, maintaining their dignity, and receiving skilled medical care.
Medicare can cover all or part of home healthcare costs when paying for this service, provided certain conditions are met, such as being considered homebound and requiring skilled nursing.
What Is Medicare?
Medicare is a federal health insurance program designed to support specific groups of people, including those aged 65 and older, certain younger individuals with disabilities, and those with specific illnesses such as end-stage renal disease.
For many, Medicare is an essential lifeline, helping cover healthcare expenses that would otherwise be overwhelming.
What Is Home Healthcare?
Home healthcare includes a wide range of medical services—all provided in the comfort of one’s home. It goes beyond traditional care by blending skilled medical attention with the comfort and familiarity of a home environment.
Services typically range from:
- Skilled nursing care
- Physical therapy
- Speech therapy
- Occupational therapy
- IV therapy
- Wound care
- Medical social services
Whether recovering from surgery, managing a chronic condition, or needing therapeutic support, home healthcare aims to improve quality of life.
Criteria for Medicare Coverage
Though Medicare can assist with the costs of home healthcare, eligibility is based on meeting specific criteria, including:
- Confirmation of homebound status
- The necessity of skilled care
- Obtaining a healthcare professional’s certification
- Receiving care from a Medicare-certified home health agency
Homebound Status
You must be considered “homebound” to qualify for home healthcare. Being homebound means leaving home requires considerable effort or assistance, such as using a wheelchair, walker, or crutches.
When a doctor determines it is unsafe or medically inadvisable for you to leave home, you may also qualify under this status. Your doctor must sign a home health certification that confirms you are both homebound and qualify for assistance from Medicare.
Necessity of Skilled Care
The services you receive must be categorized as “skilled care.” These services may include medical or therapeutic services that require the expertise of licensed professionals, such as a nurse or therapist, to provide safety and efficacy.
You must require skilled care intermittently, which means a few times a week or a few times a month.
Medicare-Certified Home Health Agency
You must receive care from a Medicare-certified home health agency to receive coverage. Agencies such as Bethany Village Home Health Care adhere to specific federal standards for quality and compliance, making them eligible to bill Medicare directly for your care.
Healthcare Professional’s Certification
Obtaining a health professional’s certification is critical to qualifying for Medicare coverage. A physician must confirm your medical need for home healthcare and create a personalized care plan detailing the services you require.
Your physician should submit a signed home health confirmation certification and the care plan to Medicare on your behalf.
What Home Healthcare Services Does Medicare Cover?
Medicare’s home healthcare coverage spans various medical and therapeutic services essential for a comprehensive recovery. These may include:
- Skilled nursing services, such as administering medications, IV therapy, wound care, or monitoring medical conditions
- Physical therapy, if it helps restore mobility, alleviate pain, or prevent further physical decline
- Occupational therapy to regain independence in daily activities like bathing, dressing, & other vital functions
- Speech therapy to address speech or swallowing issues caused by injury or illness
- Medical social services, provided by a social worker to connect patients to resources or counseling
- Durable medical equipment (DME), such as wheelchairs, walkers, or hospital beds, & other equipment required as part of your home care plan
What Home Healthcare Services Does Medicare NOT Cover?
Understanding what Medicare does not cover is equally important so you can avoid unexpected costs or misunderstandings about covered benefits. Medicare doesn’t cover the following:
- 24-hour home care that provides round-the-clock, continuous in-home care
- Homemaker services that fall outside the scope of medical necessity, including day-to-day tasks like cleaning, cooking, or grocery shopping
- Personal care services, such as bathing, dressing, or eating, are only covered when combined with other skilled care needs
How to Determine Eligibility & Apply for Medicare Coverage
Navigating Medicare’s eligibility process can seem complex, but following these steps can guide you toward coverage for the home healthcare you need.
Step 1: Consult with Your Doctor
Start by scheduling an appointment with your healthcare provider. A doctor can assess your medical needs, determine whether you or your loved one is homebound, and outline the care required through a comprehensive care plan.
Step 2: Find a Medicare-Certified Home Health Agency
Confirm that the provider you work with meets Medicare’s certification requirements to provide high-quality care. Bethany Village Home Health Care is Medicare-certified, so we can guide you through the process.
Step 3: Gather Documentation
Medicare requires specific documentation to process coverage. Work with your doctor and home health agency to submit necessary paperwork, such as proof of homebound status, a signed care plan, and evidence of your Medicare eligibility.
Step 4: Apply & Stay Engaged
Once your application is submitted, the process doesn’t end there. Stay engaged with your healthcare provider and agency to verify that your needs are met and that coverage issues are promptly addressed.
For more information, visit Medicare.gov.
Recovery & Support in the Comfort of Your Own Home
If you have questions or would like assistance navigating Medicare coverage for at-home care, our team at Bethany Village Home Health Care is here to help.
Contact us today to explore how our services can support your or your loved ones’ well-being. Together, we can create a care plan that helps make your house feel like home again.
