Frequently Asked Questions
What is Home Health Care?
Home care is a service provided to recovering, disabled, or chronically ill individuals who need medical treatment and/or assistance with the activities of daily living. The National Association for Home Care estimates that more than eight million Americans currently receive home care for both acute and long-term needs. Because of state-of-the-art medical equipment, treatments and services that were once available only in the hospital can now be provided in the home.
Who qualifies for Home Health Care?
A person who is:- Homebound
- In need of the skilled services of a nurse or a therapist
- In need of care on an intermittent basis
- Medically unstable
- Under the care of a physician
What Home Health Services does Medicare cover?
- Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse).
- Home health aide services on a part-time or intermittent basis. A home health aide doesn’t have a nursing license. The aide provides services that give additional support to the nurse. These services include help with personal care such as bathing, using the bathroom, or dressing. These types of services don’t need the skills of a licensed nurse. Medicare doesn’t cover home health aide services unless you are also getting skilled care such as nursing care or other therapy. The home health aide services must be part of the home care for your illness or injury.
- Physical therapy, speech-language therapy, and occupational therapy for as long as your doctor says you need it.
- Physical therapy: including exercise to regain movement and strength in a body area, and training on how to use special equipment or do daily activities, like how to get in and out of a wheelchair or bathtub.
- Speech-language therapy (pathology services): including exercise to regain and strengthen speech skills.
- Occupational therapy: to help you become able to do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and new ways to do other usual daily activities. You may continue to receive occupational therapy even if you no longer need other skilled care if ordered by your doctor.
- Medical social services to help you with social and emotional concerns related to your illness. This might include counseling or help in finding resources in your community.
- Certain medical supplies like wound dressings, but not prescription drugs or biologicals.
- Durable medical equipment such as a wheelchair or walker.
- FDA (Food and Drug Administration) approved injectable osteoporosis drugs in certain circumstances.
What services does Medicare not cover (does not pay)?
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services like shopping, cleaning, and laundry; and Personal care given by home health aides like bathing, dressing, and using the bathroom when this is the only care you need.
Most of the time, your doctor, a social worker, or a hospital discharge planner will help arrange for Medicare-covered home health. However, you have a say in which home health care agency you use.
How much does Home Health Care cost?
Home health care is covered by Medicare (Either Part A or B), Medicaid, and most private insurance. If you don't meet the admitting criteria or are opting for a service not covered by your insurer, you may choose to pay "out of pocket" for services.
I have Home Health Care from another agency, but am not happy; what can I do?
Anyone can get home health care from nearly any home health agency (depending on the insurer). If you are not satisfied with the staff or quality of care you are receiving, you should first try to contact the Agency Administrator and voice your concerns. If you are still not satisfied, you can change agencies with a few phone calls. Contact your doctor and tell him/her about your request. In most cases, another agency can continue services the next day.
You may visit the Medicare website for expanded information regarding your current Home Health Care coverage as well as many other coverage topics under the Original Medicare Plan.