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Some medical issues that affect the elderly, such as an injury from a fall or a heart attack, will occur unexpectedly. And, while the acute stage of the condition may only last for a short time, the road to full recovery may require additional assistance such as in-home care. The good news is that certain home healthcare (HHC) services are available from Medicare.

How Would My Aging Loved One Qualify for Home Healthcare?

To make use of the available HHC services, an individual must:

  • Meet the criteria for being homebound established by the Centers for Medicaid & Medicare (CMS).
  • Require skilled part-time or intermittent care to maintain, improve, or slow the progression of their health condition.
  • Be receiving care from a medical professional, who has documented an in-person visit either three months prior to the start of HHC, or within one month after the HHC benefit has begun.
  • Receive HHC from a Medicare-approved home health agency.

Example: Your aging parent suffers a fall and undergoes surgery on their knee. They spend three days in the hospital before being discharged. The patient’s doctor completes discharge documents that will include information about your parent being homebound and requiring short-term skilled care. The documentation will also include a home healthcare plan that will notify Medicare and healthcare agencies of the type of services and/or equipment that will be needed. Your parent is now eligible to receive home healthcare from a Medicare-approved agency.

What Specific Services Does Medicare Cover?

Eligible individuals qualify for in-home skilled nursing and rehabilitative care from approved home healthcare providers. These services include physical therapy, speech-language pathology, occupational therapy, and access to durable medical equipment, medical supplies, and medical social services.

How Much Does Home Healthcare Cost?

If someone is enrolled in Original Medicare, they are not charged anything for home healthcare services. However, they may have to pay for 20% of the amount that Medicare has approved for the provision of durable medical equipment. Note that benefits and costs may be different for a beneficiary enrolled in a Medicare Advantage plan. 

What Does Medicare Not Cover? 

Medicare does not cover custodial care, including twenty-four-hour care, personal care not included in an HHC plan, homemaker services, and meal deliveries. However, Medicaid may pay for some services that help to keep seniors in their homes. The requirements for enrollment and services covered vary by state.

Help Is Available

If all of the above seems complicated, you can contact your local State Health Insurance Assistance Program (SHIP) for Medicare counseling at no charge. There is also another helpful free program called Benefits CheckUp, which screens for thousands of programs, including adult daycare, local respite care, and state Medicaid programs. 

If You Are Looking for In-Home Care in Columbia, SC

Caring Healthcare provides in-home care for elderly individuals who have extra healthcare needs due to an unexpected disability or illness. If you need home healthcare on a short- or long-term basis, talk to us to find out how we can help you.