Home Health Care

by David Bynon, last updated

What is Home Health Care?

Health care services are medical care and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered by your doctor.

Most people do not want to stay in a hospital, skilled nursing facility, assisted living facility, or rehabilitation facility for weeks or even months recovering from an illness or injury. They would rather be in the comfort of their homes. The problem is that those individuals still need to be monitored to ensure they are recovering well. This is how home health care services and agencies came about – they deliver the services a hospital or medical facility would but at the home of the person who requires them.

There’s a lot to learn about home health care services, especially how they are paid for, whether out-of-pocket or by Medicare. In this article, we’ll help you learn everything you need to know about home health care here to see if it’s the right type of service for your older loved one.

What Is Home Health Care?

Medicare defines home health care as “a range of health care services that can be given in your home for an illness or injury.” In other words, individuals can receive services that maintain or improve health while in the comfort of their homes.

Home health care services are not only for those who are elderly. It’s for anyone who requires health care services in their home. However, since home health care services can support the aging population in the United States, this population is the one that receives these services the most. According to the president of the National Association for Home Care and Hospice Bill Dombi, “The demand for home care and hospice continues to grow as we see a graying of the U.S. population.” These services can include:

  • Wound care after surgery
  • Patient and caregiver information
  • Intravenous or nutrition therapy
  • Injections
  • Health monitoring

The goals of home health care are to improve the health of the individual to:

  • Become more independent and self-sufficient
  • Slow decline due to the aging process
  • Maintain functioning despite a medical condition

Home health care services are meant to help individuals stay in their homes, instead of moving to rehabilitation or assisted living facilities (read this to learn more about assisted living).

How Does Home Health Care Work?

In-home care is offered by home health care agencies who have trained, licensed, and insured skilled nurses available to provide their services to individuals who meet their requirements. When someone is referred to a health care agency by a doctor or medical facility, the agency reaches out to the person to schedule an appointment for an assessment. Those who need the services or their caregivers can also contact a home health care agency to seek services. However, a doctor will need to provide some documentation about the person’s needs to help the home health agency understand the level of care required for the individual.

During the assessment appointment, the home health care nurse will ask questions to determine the level of care required. Some of the questions may be:

  • What do you need help doing to keep you safe and healthy in your home?
  • Are you able to take your prescription medication correctly at the right time?
  • Are you able to cook yourself nutritious meals?
  • Has your doctor discussed your fall risk? What did he say about it? Do you have any documents about it?
  • Do you have a loved one helping you now? How often?

If the caregiver is present, the home health care nurse may ask: What do you believe your older loved one needs from home health care services?

In addition to the interview, the health care worker may ask for permission to speak to treating doctors. This will help with the assessment process and when it comes time to create a treatment plan.

Each individual receives a personalized treatment plan including the services being offered and the frequency of those services. The start date and end date will be included in the treatment plan, and Medicare will receive this plan for care. Medicare must approve the plan to have the services covered.

Medicare Coverage for Home Health Care

Medicare is one of the best ways to pay for home health care if you qualify for it.

Skilled nursing services are covered by Medicare and are performed by or under the supervision of a nurse who will treat the injury or illness. This type of care is covered by Medicare for up to seven days for no more than eight hours a day. The maximum number of hours Medicare will cover is 35 hours per week.

A home care aide providing personal care services is not covered by Medicare. The only part of home care services that are covered is the skilled nursing ones. In other words, the services provided by a licensed or certified nurse who is offering medically-based services to treat or help someone recover from an injury or illness.

Medicare does pay for medical social services, as long as the doctor orders it and it helps with your social and emotional issues related to your illness or injury.

Medical supplies are covered in full, as long as they are provided by a Medicare-certified home health agency (HHA). This includes wound dressings and catheters.

Medical equipment, such as walkers or wheelchairs are only partially covered. Medicare pas 80% of the approved amount of them.

Medicare pays for skilled nursing services, home health aides providing skilled care, medical social services, medical supplies, and partial payment for medical equipment for individuals with temporary or chronic conditions.

How Much Does Home Health Care Cost Medicare Beneficiaries?

Costs for home health care services can vary among agencies and the number of hours depends on the needs of the individual receiving services. Those who require home health care can expect to pay slightly more per hour. The national average is $22 an hour. Usually, those who suffer from conditions such as Alzheimer’s disease need the medical component of home health care services. Even so, the cost of these services is much less expensive than the cost of residential care.

Home health care costs from Medicare-certified agencies have been approved by Medicare. Medicare will only pay for services offered by the ones they approve, as to not overpay for services. Individuals who pay out-of-pocket for home health care services should seek those from Medicare-certified home health agencies, as those are held to stricter standards and price their services at what Medicare believes is fair.

How Long Does Medicare Cover Home Health Care Services?

Medicare will pay the full cost of home health care for up to 60 days at a time. This is because Medicare believes that by 60 days the person should be recuperated from their injury or illness. If the injury or illness has not stabilized in 60 days, an additional 60 days may be granted. The individual receiving Medicare coverage for their home health care must be re-evaluated by a doctor to determine if those services continue to be medically necessary.

Home health services covered by Medicare are not meant to be long-term or forever. However, individuals can continue to receive those services for as long as the treating doctor deems them as necessary for recovery or at least stabilization.

Medicare will only pay for home health care services offered by Medicare-certified home health care agencies. There are more than 11,000 home health agencies in the nation and new ones are being certified all the time.

What Qualifies a Person as Homebound?

Medicare will only cover home health services for individuals who are identified as homebound. Medicare considers someone as homebound if the person requires the help of another person or medical equipment (crutches, walker or wheelchair) to leave home. If a doctor believes the person’s illness or injury will worsen leaving the house, that is also a factor in being considered homebound.

A doctor can decide if a patient is considered homebound through an evaluation of the condition. A plan of care will indicate whether a person is homebound or not. Homebound status must be re-evaluated every 60 days.

Keep in mind that homebound doesn’t mean someone can’t leave the home. It means it is difficult to leave home. Homebound individuals can still go to religious services, medical appointments, adult daycare centers, and family events without risking their status, which could lead to losing Medicare coverage for home health services.

What Is the Difference Between Home Health Care and In-Home Care?

Home HEALTH care is different from home care. The inclusion of “health” is what makes it different. With home health care, individuals receive assistance with the medical condition or injury, while home care does not provide that support. The following are what home health care offers vs. what home care offers.

Home Health Care:

  • Rehabilitation Therapy
  • Administers Medication
  • Performs Medical Tests
  • Monitors Health Status
  • Reminders to Take Medicine
  • Skilled Nursing
  • Wound Care
  • IV Therapy and Injections
  • Covered by Medicare
  • Covered by Medicaid or Medicaid Waiver Program
  • Private Health Insurance
  • Private Pay

In-Home Care:

  • Meal Preparation and Delivery
  • House Cleaning
  • Assistance with Bathing, Dressing, and Grooming
  • Transportation
  • Reminders to Take Medicine
  • Incontinence Care
  • Toileting Help
  • Companionship
  • Covered by Medicaid or Medicaid Waiver Program
  • Private Pay
  • Long-Term Care Insurance

The only ways that home health care is the same are:

  • Reminders to Take Medicine
  • Covered by Medicaid or Medicaid Waiver Program
  • Private Pay

As you can see, they are very different from each other and some individuals may need both types of services to remain safe and healthy in their homes.

Do Medicare Advantage Plans Cover Home Health Care?

Yes, most Medicare Advantage (MA) plans pay for convalescent home health care services after a stay in the hospital. However, very few MA plans cover in-home services that are not directly required for recovery.

As of 2019, MA plans are allowed to cover various in-home care services, but few insurers have chosen to do so as of the 2020 plan year. However, some experts feel in-home benefits could gain traction over the next few years, particularly in the wake of the COVID-19 pandemic.

Do Medicare Supplement Plans Cover Home Health Care?

Medicare Supplement Insurance works in lock-step with Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Because Medicare Part A and Part B do not cover home care as a standard benefit, Medicare Supplement plans generally don’t, either.
To be eligible for Medicare and supplemental coverage, a doctor must certify that home health care services are medically necessary as part of your treatment plan and that you are homebound.
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