Qualifying for Home Health Care on Medicare

by David Bynon, last updated

Does Medicare Cover Home Health Care

As people age, their risk of becoming injured or ill increases, and hospital stays may not always be the best solution for recovery. Being able to be at home for healing is much more comfortable, which can speed up the time it takes to recover. The only issue is that having home health care can be expensive, and most people can’t afford it. That’s why they wonder how they can qualify for home health care through Medicare.

This article covers the ins and out of Medicare’s coverage of home health care and options for receiving financial assistance.

When Medicare Pays for Home Health Care

Medicare will only pay for short-term home health care. The government-run program provides financial assistance for medical services and equipment needed for recovery, as long as the individual is considered “homebound.”

Homebound refers to an individual requiring skilled care at home on a part-time basis to recover from a health condition. A doctor recommends and documents the need for home health care one to three months before it begins, and the care comes from a Medicare-approved home health agency.

An example of this is an individual falls and injures her shoulder. After shoulder surgery, she will need to stay in a medical bed to ensure she doesn’t fall again and monitoring because the pain medication can increase her blood pressure. Since the person has been in the hospital, and the doctor recommends home health care, Medicare approves her for home health care services from one of its agencies.

The reason the person qualifies for home health care is that the recovery period is short – six weeks. Following six weeks, the individual would not be eligible for home health care services from Medicare.

About Long-Term Home Health Care

Medicare will not pay for long-term home health care, but Medicaid may be able to help. Medicaid is for those who have a low income. Maximum income depends on the state where the person lives and changes every year, so checking with the local social services office is the best way to know about eligibility.

Medicaid may also pay for home health care services if an individual already receives benefits under Supplemental Security Income (SSI). These people meet one of these:

  • Be 65 years of age or older
  • Have a permanent disability as determined by the Social Security Administration
  • Be blind

Out of the people who meet one of the above, they must also meet all of these:

  • Be a citizen of the U.S. or meet immigration rules
  • Be a resident of the state where applying
  • Have a social security number

Other Options for Home Health Care Financial Assistance

In addition to Medicare and Medicaid, people can pay home health care services with veterans benefits if they served or have a loved one who served in the military. Long-term care insurance is another way to pay for it, but the person must have it before needing the care. Some private health insurance policies cover long-term home health care, but they are usually expensive and limited.

Home health care is vital to people who want to stay in their homes for as long as possible as they grow older. For more information about whether or not someone qualifies for home health care financial assistance, contact the local social services office about Medicare and Medicaid, depending on how long the person needs care.

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