An Ultimate Guide on Medicare Coverage for Home Health Care

medicare in home health care

What is Medicare?

Medicare is the federal health insurance program. It is age or diagnose-based and intended for people aged 65 or older, younger people with disabilities, and people with permanent end-stage renal disease (permanent kidney failure that requires dialysis or a transplant), or Lou Gehrig’s disease (ALS). You can receive Medicare benefits under four different parts: A, B, C, and D.

What is Home Health Care?

Home health care involves a wide range of medical care that you receive in your home for illness or injury. Home care is intended to treat disease or injury and help you live independently for as long as possible.

Which Home Health Care is Covered by Medicare?

Medicare covers services that include intermittent skilled nursing care, therapy, and care provided by a home health aide to people who are homebound (entirely confined to their home). Home health aide provides medical care and helps with medications, braces, and other medical equipment. It can also provide a higher level of skilled nursing.

Depending on your eligibility, you can receive Medicare home health care coverage under Part A (hospital insurance) or Part B (medical insurance). Medicare pays the full cost of home health care under both plans.

Home health care is normally covered by Part B. Under Part B, you need to be homebound and need skilled care to qualify for home health care. Under Medicare Part B, there is no prior hospitality requirement.

Under Part A, you are eligible for home health care coverage in certain circumstances after you spend at least three days in a hospital or have a Medicare-covered stay in a skilled nursing facility. In this case, Part A will cover the first 100 days of your home health care.

Nevertheless, you still need to meet certain eligibility requirements, such as being entirely confined to your home and needing skilled care. Also, you must receive home health services within 14 days of your hospital or skilled nursing facility to receive home health care under Medicare Part A.

How Much Does Medicare Pay for Home Health Care?

The average hourly cost of home health care in Arizona is $23.25, and it is normally less expensive than the care you would receive in a hospital or skilled nursing facility. Statewide, the cost of non-medical home care ranges from $16 – $28 per hour. Medicare covers 100% for skilled health-care services as long as you are homebound.

However, Medicare won’t cover for home aides that help with household services (housework, cooking, shopping, laundry) and personal care (bathing and dressing). Also, Medicare doesn’t cover long-term care for conditions like Alzheimer’s or cancer.

Can Medicare Pay for a Caregiver?

In some instances, Medicare pays for a caregiver up to 60 days if your doctor certifies that you need at least one of the following services: physical therapy, intermittent skilled nursing care, continued occupational therapy, or speech-language pathology services.

Also, the home health agency whose services you are receiving needs to be Medicare certified.

According to Arizona’s Self-Directed Attendant Care (SDAC), you are allowed to hire, train, and let go of your care providers. You can hire family members, including spouses and adult children, as personal care providers, also called Attendant Care Workers.

Who Qualifies for Home Health Care Services?

To qualify for home health care, you have to meet certain criteria. Firstly, you need to be considered homebound, which means that you cannot leave your home without help because of illness or injury, or it is not recommended for you to leave home because of your condition. Your doctor needs to certify that you are homebound and require at least one of the following services:

  • Intermittent skilled nursing care
  • Physical therapy
  • Ongoing occupational therapy
  • Speech-language pathology services

Finally, home health care needs to be provided from a Medicare-approved home health agency.

What Does Home Health Care Include?

Many people require medical assistance after the age of 65. Home health care includes medical care services in your home that you receive for illness or injury.

Home health care includes services such as intermittent skilled nursing, occupational therapy, physical therapy, and speech therapy. Home health care is typically carried out by licensed therapists, nurses, or home health aides who work for hospitals, home health agencies, or public health departments licensed by the state.

Does Social Security Pay for Home Health Care?

It depends upon the circumstances of your disability, as every person’s case is different. Social Security is the foundation of economic assistance for disabled persons, retirees, and families of disabled, retired, or deceased workers. About 61 million Americans collect Social Security monthly benefits.

If you are disabled and approved for Social Security Disability Insurance (SSDI), you will receive Medicare insurance. Medicare will help pay for home health care as long as you are considered homebound and receive skilled care. You also have to attain the doctor’s approval that you qualify for Medicare under the aforementioned circumstances.

Is Visiting Angels Covered by Medicare?

Visiting Angels is a national, privately-owned network of home care agencies that provide non-medical home care services for senior citizens. Visiting Angels provide a range of services, including home care, senior personal care, respite care, companion care, and elder care services. Medicare may help cover for these services. Keep in mind that Medicare mostly covers short-term care rather than long-term care for health conditions.

For Medicare to cover Visiting Angel’s services, a doctor must certify that you have been in a hospital for at least three consecutive days, require therapy, or began care within thirty days of the hospital stay. If you fulfill all three requirements,

Medicare will cover 100% of your health care for twenty days.

How Much Does Private Home Care Cost?

The cost of private home care depends on several factors, in the first place, on the number of hours the designated care worker spends with you. It also depends on the kind of services and the supplies needed to assist you with your condition.

Every U.S. state has its own median cost of private home health care. However, the national average is around $4,000 per month, while an average hourly rate nationwide comes to around $20 dollars.

 

Home Care & Home Health Care Average Price Charts

Below you can see some charts from a GenWorth study that shows the average cost for home health care or home care costs in America.

how much arizona home care costs
home health care cost comparison arizona genworth

What Are The Benefits of Home Health Care?

For many families with aging members, home health care is a beneficial option that assists the family, while allowing seniors to stay in their homes and communities. If you are caring for an aging parent or another senior member of the family, you may find home health services very helpful.

Firstly, your loved one will always have a caring companionship and assistance when you are not able to physically be there for them. Also, home health care will provide your loved one with access to skilled nursing care at home and ensure that their medical needs are met. They will also have support with medication management and assistance with diet and nutrition.

Finally, home health care is an affordable alternative to hospital or facility care – according to the National Association of Home Care, the average cost of home health care is $133 dollars per day, while the average cost of care from a skilled nursing facility is $544 dollars per day.

How Can I Help My Elderly Parent Stay at Home?

Many people find it challenging to adjust to changes and losses that occur as they grow older. In addition, a large number of people aged 65 and older experience impaired health or injuries that severely affect their day-to-day life and habits. So, caring for your aging parent may be overwhelming at times.

If you and your elderly parent don’t find moving to a skilled nursing facility appealing, home health care may be the best option as it allows your aging parent to stay at home and still receive all the assistance needed.

Consider your parent’s needs and the level of assistance needed, so you understand how much help your parent needs to stay safe in their own home.

If you are thinking about hiring a home care agency, here are some good initial questions:

  • Does your parent need help 24/7?
  • Can your elderly parents manage medications on their own?
  • Do they need help with grocery delivery or transportation?
  • Do they need assistance in getting dressed, feeding, or bathing?
  • Can they engage in some sort of physical activity?
  • What is the condition of their mental health?

And here is a downloadable or viewable PDF on 20 Questions You Should Ask A Homecare Agency.

How Much Will Medicare Pay for Mental Health Services?

Medicare will cover the outpatient mental health services under Part B at 80% of the Medicare-approved amount. So, as long as you receive mental health services from a participating provider, you will pay a 20% coinsurance after you meet your Part B deductible.

Mental health services that Medicare Part B may cover include:

  • Psychiatric evaluation
  • Annual depression screenings
  • Individual and group therapy
  • Medication management
  • Substance use disorder treatment
  • Family counseling (as part of your treatment)
  • Outpatient psychiatric services (partial hospitalization)

Medicare will cover the services from the following types of providers:

  • Psychiatrists
  • Clinical psychologists
  • Clinical social workers
  • General practitioners
  • Nurse practitioners
  • Physicians’ assistants
  • Clinical nurse specialists
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