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, costs may be covered for several necessary services for loved ones who are homebound because of a chronic illness or injury.
Medicare beneficiaries have no copayments for approved services, which can help with recuperation.
“Not only can home health care help to avoid accidents and falls, but it can increase your loved one’s happiness,” says Gretchen Jacobson, vice president of Medicare for the Commonwealth Fund.
What does ‘homebound’ mean?
Someone is considered ‘homebound’ when he or she has trouble leaving home without the help of either a person or medical equipment because of illness or injury.
A patient whose doctor recommends not leaving home because of a medical condition is also considered homebound.
Note: Attending adult day care, religious services, medical appointments or some special occasions will not cause patients to lose their homebound status under Medicare rules.
The home benefits have proved popular: From 2002 to 2019, the number of Medicare beneficiaries using home health grew by more than 30 percent, according to a Commonwealth Fund report. 2020 had a 6 percent decline as the COVID-19 pandemic took hold, but even that year had nearly 2.9 million home health users among beneficiaries and about 8.9 million home health claims.
What kind of help is covered by Medicare?
Medicare will pay for several categories of workers at home. Each type of home health care professional delivers different services.
- Home health aides. They can provide either part-time or intermittent home health care. They may assess pain; check blood pressure, breathing, heart rate and temperature; and ensure that medications are being taken correctly. They may also evaluate the safety of the home, monitor food and drink intake, and teach patients and caregivers about the plan of care and how to carry it out. Medicare will only cover home health aides if you’re also receiving skilled nursing or therapy.
- Medical social workers. These professionals help with emotional concerns and with understanding a disability or illness.
- Occupational therapists. They help people do the daily activities they need to live life more easily.
- Physical therapists. They help restore movement in those who might have weakened from time spent in the hospital.
- Skilled nursing care. Registered nurses or licensed practical nurses under the supervision of a registered nurse can change wound dressings and give injections, intravenous drugs or tube feedings. They can also teach about diabetes care and prescription drugs.
- Speech-language pathologists. They may be used after strokes to help restore communication and swallowing.
Does Medicare caregiving coverage have limits?
Services are restricted to either fewer than seven days a week or to less than eight hours a day for up to 21 days.
Medicare home health benefits do not cover full-time skilled nursing care or prescription drugs. They also do not cover housekeeping, meal delivery or transportation.
What are the costs under Medicare?
If you qualify for home care benefits and use a Medicare-certified home care agency, you don’t have to pay a deductible or copayments for eligible home care.
Home care is generally covered under Medicare Part B. But it can be covered through Part A in some cases after you have been in a hospital as an inpatient for at least three days or a Medicare-covered skilled nursing facility.