What Home Health Services Does Medicare Cover?
One of the most asked questions I get regarding Medicare benefits is "what Home Health Services are covered by Medicare". Must everyone I know would rather recover at home from an illness, injury or surgery to an extended hospital or nursing home stay. The good news is that often home health care will be covered if you are considered “homebound” by Medicare . Homebound means it is very difficult to leave home. This definition has been broadened during the coronavirus public health emergency. Homebound means you need skilled nursing and/or skilled therapy care.
To be considered homebound, you’ll need a face-to-face meeting with a doctor within 90 days before or the 30 days after you begin receiving care. This meeting can be facilitated by technology such as a video phone chat or zoom meeting. After meeting face-to-face meeting, your doctor signs a home health certification and approves your “plan of care”. You’ll then receive care from a Medicare-certified home health agency (HHA).
Medicare covers skilled nursing care and home health aide services provided up to seven days per week for no more then 8 hours per day and 28 hours per week. In certain cases, you could receive up to 35 hour per week. You can continue to receive home health care for as long as you qualify. Your doctor must review your plan of care and re-certify it every 60 days. Medicare covers your home health care even if your condition is chronic or you’re not showing signs of improvement.
If you qualify for home health, Medicare will cover the follow services:
· Skilled nursing services
· Home health aides
· Medical social services
· skilled therapy services such as physical therapy, speech therapy and occupational therapy
· Certain medical supplies such as wound dressings and catheters
· Certain durable medical equipment such as oxygen, wheelchairs and walkers
Telehealth and Home Health Care
Telehealth visits with doctors and health care providers grew rapidly in use and popularity during the Covid-19 pandemic. Telehealth services are when you use technology that allow both audio and video communication with a health professional. Depending on the situation, you might access telehealth from your home or from a medical facility.
Prior to the pandemic, Original Medicare only covered telehealth in limited situations such as living in a rural area or needing services due to an acute stroke or behavioral health condition. During the coronavirus pandemic, Medicare expanded the telehealth services. Medicare now covers hospital and doctor office visits, preventive screenings and many other services via telehealth.
If you’re on Original Medicare with a Medicare Supplement, standard cost-sharing applies. If you’re on a Medicare Advantage plans, you may find some of the telehealth visits have no co-pay. If you have Medicare Advantage, you should contact your plan and inquire about cost and coverage rules for telehealth appointments.
If you are home-bound, most Medicare Advantage and Part D prescription plans offer mail order options that allow prescriptions to be delivered to you. Contact your Medicare Advantage or Part D plan provider for information and rules on home delivery. Customer Service numbers are on the back of your member card. Some pharmacies also offer free home delivery of prescription drugs.
Call Medicare at 1-800-633-4227 for helping finding Medicare certified home health agencies (HHA) in your area or for questions about home health care benefits if you are on Original Medicare.
If you have a Medicare Advantage (MA) plan, call the member services phone number on the back of your member ID card for specific information about costs and coverage rules for home health care and telehealth appointments. Your MA plan can also provide you with a list of in-network HHA’s in your area.