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Medicare Coverage in Home Care

Keeping up with medical costs as you age can get quite difficult, and while home health care services are often cheaper than nursing care, they still aren't cheap. Fortunately, Medicare can cover part, and sometimes most, of the expenses associated with hiring home health aides.

However, there are certain criteria you must meet to qualify for the financial aid. Below is a brief explanation of how you can qualify for coverage, what it will cover, and what it likely will not cover.

Will Medicare Cover my Home Health Care services?

Yes, but this depends. To gain financial support for services from home health aides, you must qualify under multiple criteria to be covered. You can be covered if:

  • You have been ordered by a doctor to seek in home medical care.
  • You need specialized help, such as nursing care or physical, speech, or occupational therapy.
  • Your desired health care agency is on a list approved by Medicare, and
  • You are home bound. This doesn't mean that you are unable to leave your house, but that doing so typically takes much effort.

If you qualify under all four criteria, Medicare will cover home health care services for home health aides. However, if you are only looking for help in non medical areas, chances are that Medicare will not cover it.

What Services will Medicare Cover?

  • Nursing care: Certified nursing professionals who are able to administer medication and dress wounds, among other medical procedures.
  • Care by certified nursing assistants: CNAs are home help aides able to care for sensitive issues such as bathing, incontinence care and grooming, but are unable to offer the kind of medical care that a nurse can.
    • Note: Medicare will only cover care in this area if it is needed in addition to nursing care. It will not be covered if you are seeking only a non-medical health aide alone.
  • Specialized therapy: If you have been ordered by your doctor to start or continue specialized therapy, medicare will cover it. This includes:
    • Speech therapy
    • Occupational therapy, and
    • Physical therapy
  • Medical social services
  • Some medical supplies and equipment

What Home Health Care Services Won't Medicare Cover?

  • Non-medical home health care services: If the service does not involve care that must be administered by a medical professional, Medicare will likely not cover it. This accounts for caregiver items such as shopping, cleaning, or transportation.
  • Specialized home health care services that deal with every day care but don't additionally cover  medical services such as medication and treatment. For example, home health aides that deal with bathing and bathroom help alone will not be covered if you are not seeking their help in addition to medical care from a medical professional such as a therapist or registered nurse.
  • Around-the-clock medical home care.

In conclusion, Medicare can cover part of the services provided by home health aides as long as you meet the above criteria, the most important being a doctor's referral to seek home health care services. Among the services covered are nursing care, specialized therapy, and certain medical supplies.

An important point to remember is that non-medical help from home health aides may be able to be covered, but only when you need medical home health care services as well. If not, you likely will not be able to have Medicare cover part of it. Also, Medicare will offer-short term assistance, but in most long-term situations, it will not be able to provide continued financial support. For more information on this, please check our page on recent changes to home health care services.

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