Any one of us could, unfortunately, experience a health emergency. We could fall and break a leg, become injured in a car accident, or suffer a heart attack. These scenarios typically occur when they are least expected, but only last for a relatively short period of time. However, while we are on the road to recovery, we may require additional assistance, including some in-home care. The good news is that help is available through Medicare’s home health care (HHC) services.

How Does Someone Qualify for Home Health Care From Medicare?

To be eligible for home health care provided by HHC, you must meet the following criteria:

  • Be considered homebound, as defined by Medicare.  
  • Require skilled care on an intermittent or part-time basis to maintain, improve, or prevent further deterioration of your health condition.
  • Be under the supervision of a medical professional, who documents a personal visit with you either: a) three months before the beginning of HHC, or b) within one month following the initiation of the HHC benefit.
  • Receive HHC from a Medicare-approved home health agency.  

Here’s an example. Let’s say you take a spill from your bike and wind up in the hospital where you receive needed surgery on your knee. You get discharged after three days, but your knee is not completely healed, and you have difficulty getting around. Your hospital discharge documents will state that you will be homebound and need short-term skilled care. You will also receive a health care plan that informs Medicare of what kind of equipment and services you will need. This makes you eligible to receive home health care from a Medicare-approved organization.

What Services Does Medicare Cover?

If you meet the eligibility requirements for Medicare home health care, you are entitled to receive certain services from approved home health care organizations. These services include medical social services, occupational therapy, physical therapy, speech-language pathology services, and the provision of durable medical equipment and necessary medical supplies.

How Much Does Medicare Charge for Home Health Care Services?

If you are enrolled in Original Medicare, you will not be charged anything for home health care services with one exception – you may be required to pay for 20% of the Medicare-approved amount for durable medical equipment. Also, if you have a Medicare Advantage plan, benefits and costs may differ.

What About Long-Term Home Health Care?

Medicare will not cover any personal care services outside of those included in an HHC plan. This means that, unfortunately, Medicare does not cover long-term or custodial care for people diagnosed with long-lasting or chronic conditions such as Alzheimer’s or cancer. However, Medicaid will sometimes pay for services to keep seniors in their own homes. Requirements for coverage vary by state. To find out what’s covered and if you are eligible, contact your state’s Home and Community Based Services program.

Where Can I Get More Information About Home Health Care?

A useful online link is BenefitsCheckUp®, a free screening program from the National Council on Aging (NCOA). You can use this tool to screen thousands of money-saving programs, including state Medicaid programs, adult day care services, and local respite care. Another recommendation is to get in touch with your local State Health Insurance Assistance Program (SHIP) for Medicare counseling at no cost to you.

The Best In-Home Care in Columbia, SC

At Caring Healthcare, we have been taking care of people in their homes for more than twenty-three years. We provide in-home care for the elderly, special needs children, and individuals with extra health care needs due to illness or disability. If you are looking for in-home care on a short- or long-term basis, give us a call to see how we can help you.