Medicare coverage for home health care can be confusing. Many services that are paid for in some circumstances are not in others. In addition, there are many vital in-home programs that provide needed care, aging-in-place and extended recovery support that are not covered by Medicare.
Medicare Coverage for Home Health Care: When Services are Not Covered
Personal care services such as bathing, dressing, grooming and toileting are often performed by home health aides. If those services are delivered as part of physician-ordered skilled nursing or therapy treatments, they are probably covered by Medicare. However, when those services are provided independently of a physician-ordered treatment, Medicare does not pay for them.
Important Home Care Services Not Paid by Medicare
There are many home care services that home-bound seniors and children and adults with special needs require for physical, mental and emotional well being. Medicare coverage for home health care does not pay for many of these necessary services, including:
Personal Care. As discussed above, personal care services involve bathing, dressing, and toileting assistance. It can also include monitoring temperature, blood pressure, and food or water intake/out-take. Assistance with ambulatory devices, changing colostomy bags and reinforcement of bandages may also be included.
24 Hour Care. If your loved one requires around-the-clock nursing or other support services, you will want to work with a qualified home health agency that provides these services on a short and long-term basis. Many offer programs that can be tailored to meet your specific needs.
Homemaking Services. When your loved one becomes unable to manage laundry, cooking, vacuuming and other homemaking chores, they will require in-home assistance. Homemaking services may also include dusting furniture, cleaning out the refrigerator, mopping floors and other tasks requested by the client.
Companionship Services. Sometimes all a home-bound person needs is the company of another individual to bolster their physical, mental and emotional well-being. Companionship provides this needed socialization and often includes stabilization while walking, light housekeeping duties and minimal grooming and cosmetic assistance. The companion will also notify you if your loved one is experiencing personality, memory or other changes that must be addressed.
Home-Delivered Meals. If your loved one is unable to prepare meals, a companion or homemaking service will provide nutritious meals to assure they do not become malnourished.
Funding for Services Not Included in Medicare Coverage for Home Health Care
Other sources of funding and service options are available to address what Medicare coverage for home health care does not pay. Your loved one may not qualify for all of these programs, but you may find your out-of-pocket burden eased by utilizing one or more of them.
Medicaid. Each state has its own Medicaid program so coverage and eligibility will vary. Unlike the Medicare program, Medicaid does fund custodial in-home care which includes many of the above services. Their community-based programs often include home-delivered meals and transportation services.
Veteran Benefits. There are a variety of home health benefits available to veterans, each with their own qualification requirements. They include:
- Homebound Program
- Homemaker and Home Health Aide Program
- Skilled Home Care Services
- TeleHealth Care
- Home Based Primary Care
To apply for any of these Veterans benefits, contact your VA social worker/case manager and complete the Application for Extended Care Benefits (VA Form 10-10EC). You can also call the VA toll-free at 877-222-VETS (8387).
Program of All-inclusive Care for the Elderly (PACE). This is a joint Medicare/Medicaid program with the goal of keeping seniors in their homes and communities. To qualify for PACE you must:
- Be 55 or older
- Live in the service area of a PACE organization
- Need a nursing home-level of care (as certified by your state)
- Be able to live safely in the community with help from PACE
PACE provides an extensive array of medically necessary services as well as meals, dentistry, preventative care, social services, counseling, and limited transportation. You can use the PACE Plan Search Page to determine if your loved one is eligible and for additional information.
Other State and Community Services
Many states and communities have services available to home-bound seniors including meal delivery, transportation, reduced-cost housing, adult day care and more. Several states have specific departments that identify and coordinate senior services and can be a good place to start. You will also want to search for options on your own, as many smaller programs are not included in state data bases.
Service funding is important, but finding the best service provider is even more critical. These are the people who will be in your loved one’s home and delivering care on a daily basis. We provide skilled and compassionate personnel that can meet the specific needs of your loved one. Contact us to learn more about our services or medicare coverage for home health care and to schedule an appointment.