Medicare, the government's medical insurance for people age 65 and older and younger people receiving Social Security disability benefits, isn't designed to pay for 24-hour care for a loved one at home.
But with a doctor's orders and plan of care, you can get costs covered for several necessary services if you are caring for a loved one who is homebound because of a chronic illness or injury.
Covered services include:
- Home health services, part-time or intermittent, provided by home health aides.
- Medical social workers, who help with emotional concerns and with understanding a disability or illness.
- Occupational therapists, who help people do the daily activities they need to live life more easily.
- Physical therapists, who help restore movement in those who might have weakened while being hospitalized.
- Speech-language pathologists, often used after strokes to help restore communication and swallowing.
- Skilled nursing care.
What 'homebound' is
• A person has trouble leaving home without help because of an illness or injury.
• Or a patient's medical condition means that leaving home is not recommended.
Attending adult day care or religious services, or infrequently going out for medical treatment or special occasions, is OK under Medicare rules.
Care can’t be full time
These services are limited to fewer than seven days a week or less than eight hours a day for up to 21 days.
Medicare also covers medical supplies and up to 80 percent of the cost of medical equipment, such as a wheelchair or walker, if a doctor certifies that it is medically necessary.
Home health care has many benefits: It is usually less expensive and more convenient for patients and can shorten their stay in a hospital or skilled nursing facility. It also can help them recuperate faster. Medicare beneficiaries have no copayments for approved services.
"Not only can home health care help to avoid accidents and falls, but it can increase your loved one's happiness,” says Gretchen Jacobson, associate director at the Kaiser Family Foundation.
It's a popular benefit: From 2002 to 2019, the number of Medicare beneficiaries using home health grew by more than 30 percent, according to a Commonwealth Fund report. There was a 6 percent decline in 2020 as the COVID-19 pandemic took hold, but even that year, there were nearly 2.9 million home health users among beneficiaries, and about 8.9 million home health claims.
How to qualify for benefits
To ensure that your loved one can take maximum advantage of Medicare home health benefits, review these important requirements:
Patients must be under a doctor's care, and the doctor must issue a plan of care that certifies the patient needs one or more of the services listed above. In addition to certifying that need, a plan of care specifies the type of health care professional who should provide the services, how often the services will be provided, any needed medical equipment, and the results the doctor expects. The doctor and the home health team review and recertify the plan of care at least once every 60 days.
Patients must see their doctor in person less than 90 days before or 30 days after home health services begin.
A Medicare-certified agency must deliver Medicare home health services. Agency personnel will coordinate the services the doctor orders. For help finding a certified agency near you, Medicare offers a tool called Home Health Compare on its website.
Types of services provided
Different kinds of home health care professionals deliver different services.
Registered nurses or licensed practical nurses under the supervision of a registered nurse deliver skilled nursing care.
- Changing wound dressings
- Giving injections, intravenous drugs or tube feedings
- Teaching about prescription drugs and diabetes care
Some of the tasks home health aides do include:
- Assessing pain
- Checking blood pressure, breathing, heart rate and temperature
- Checking the safety of the home
- Ensuring medications are being taken correctly
- Monitoring food and drink intake
- Teaching patients and caregivers about the plan of care and how to carry it out
Professional therapists provide specific kinds of services, including physical therapy, speech therapy and occupational therapy.
Social workers provide medical social services.
"Your doctor or other health care provider may recommend you get services more often than Medicare covers," Medicare's website says. “Or they may recommend services that Medicare doesn't cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.”
Medicare home health benefits do not cover full-time skilled nursing care. They also do not cover drugs, housekeeping, meal delivery or transportation.
To find out whether an item, service or test is covered under home health benefits, check Medicare's home health services page or download its What's Covered app from the Apple App Store or Google Play.
"Most family caregivers aren't familiar with Medicare,” says Amy Goyer, AARP family caregiving expert. “It's important that caregivers learn what it covers and what it does not. Part of our role as caregivers is to advocate for our loved ones."
Editor's note: This article was originally publised Oct. 11, 2019. It has been updated with more recent information on home health use by Medicare beneficiaries.
Jennifer J. Salopek has been a health care writer and communications strategist for more than 20 years. Her health care pieces have appeared in major outlets including The Washington Post. Follow her on Twitter @jsalopek.