Key takeaways on home health services and Medicare
If you can’t leave your home easily due to a medical condition, chronic illness, etc., home healthcare can offer a better way to receive necessary assistance.
Medicare generally does not cover the costs of personal care or housekeeping services provided by in-home caregivers if these are the sole types of care required.
Medicare also does not cover long-term care services.
However, if Medicare beneficiaries need medical care for recovery after surgery, illness, or injury, Medicare may pay for short-term caregiver services. Medicare might also cover some temporary in-home assistance to meet your daily needs following an illness or injury. But it must be provided by a Medicare-approved caregiver.
Additionally, Medicare coverage includes short-term home health services such as skilled nursing care, physical therapy, or occupational therapy if you are unable to leave your home and if your doctor deems it medically necessary.
Who Qualifies for Home Healthcare?
To qualify for Medicare home healthcare you must have both
Medicare Part A and Part B.
You must be homebound.
Plus you must be under a doctor’s care who has certified for your need for specific services.
Types of Home Healthcare Services
For home health care, various aides are available to help patients with diverse needs. These include:
Companion Services
They provide companionship, help individuals with daily activities, and support them in finding livelihood opportunities.
Homemaker Services
These aides assist with errands, housekeeping, meal preparation, and transportation.
Personal Care Services
They help with tasks like eating, daily hygiene, exercise, and other personal care needs.
Skilled Care Services
These providers address medical requirements, such as dressing wounds, administering medication, and providing physical therapy.
Medicare supplement insurance (Medigap)
Medicare supplement plans are administered by private insurance companies, but have no say in your healthcare. If Medicare covers a service, the supplement is required to cover its portion.
Overall, having Original Medicare and a Medigap plan is one of the best health insurance options for those who qualify… You can read more on this topic in our other articles – or watch some of our very helpful videos.
How much will Medicare cover for home health services?
If you meet the caregiver eligibility criteria described above and are eligible for Medicare coverage, you will not have to pay anything for some home services. Generally, Medicare pays 80% after the part B deductible. You or your supplement pay the remainder.
What home health services can I receive?
Medicare covers many different services, some of which may be provided in your house. Here’s what you need to know.
Occupational therapy
When receiving home-based occupational therapy, you can
anticipate a range of valuable services to enhance your daily living and functional capabilities. These services may include:
Teaching safe and effective methods to carry out everyday tasks.
Aiding in regaining functional abilities based on your specific needs and condition.
Assisting in establishing daily routines for medication management, meal planning, and personal care needs.
Providing training in energy conservation strategies and stress reduction techniques.
Assisting you in adhering to your doctor’s prescribed treatment plan and recommendations.
Physical therapy
When you receive home-based physical therapy, Medicare is likely to provide coverage for various essential services, including:
Conducting an assessment of your condition to determine your needs.
Providing gait training and exercises to aid in your recovery from surgeries, injuries, illnesses, or neurological conditions such as strokes.
Delivering wound care for injuries, burns, or lesions to facilitate proper healing and manage any associated issues.
Offering postoperative wound care to promote healing and prevent complications.
Skilled Nursing Care
If a registered nurse or licensed practical nurse visits you at home to care for you, they may:
administer IV drugs
change your wound dressings
do tube feedings
inject medications
change your catheter
teach you how to take your medications and care for yourself
Speech therapy
If a speech therapist comes to your home, they may provide:
Assistance in memory and word recognition.
Therapy to aid in the restoration of swallowing abilities.
Therapy to facilitate eating and drinking as naturally as possible.
Education on alternative communication methods if speaking is difficult.
Education on new communication techniques for individuals with hearing loss.
Home health aide
On the other hand, home health aides are expected to assist you
with the following services:
Monitoring vital signs, including heart rate, blood pressure, and body temperature.
Ensuring proper medication adherence and administration.
Evaluating the safety of your home based on your specific needs and condition.
Checking that you are maintaining a healthy diet and staying adequately hydrated.
Other services (medical social services)
You may also qualify for in-home social services, which can provide valuable support in adapting to your condition. If eligible, you could receive assistance in locating community resources like support groups to aid in your adjustment. Additionally, you may avail of social, emotional, or psychological counseling directly related to your specific condition.
In-home custodial care (personal care)
Medicare generally doesn’t provide coverage for caregivers who assist with the activities of daily living or personal care services, except in cases where it’s necessary for a temporary period during recovery from an illness or injury. Custodial care typically involves services like meal delivery, meal preparation, shopping, laundry, housekeeping, personal hygiene, dressing, and help with using the restroom. If you only require these services, Medicare will not pay for a caregiver to provide them in your home.
Additionally, Medicare does not cover:
24-hour care in your home
Full-time skilled nursing care
Housekeeping
Meal delivery
Transportation services
Homemaker services
How much does it cost to hire a caregiver?
The price of in-home care for the elderly varies, depending on the number of hours they spend with a caregiver, the services they require, and the supplies needed to support them.
The median cost of home care in the U.S. was $27 an hour in 2022. The monthly median cost of in-home, full-time care for seniors was $5,148 – based on 44 hours of care a week, as per the industry standard.
According to the 2022 Genworth Cost of Care Survey, the average hourly rate for home care in Florida is $25 per hour. The most budget-friendly options for home care can be found in Miami, Homosassa Springs, Jacksonville, and Gainesville, where the average hourly rates range from $22 to $23.50.
Who can help me pay for a caregiver?
If you or your loved one have run out of all financial resources to pay for in-home caregivers, you might be eligible for both Medicare and Medicaid financial assistance. Each state offers home- and community-based health services waiver programs, with specific eligibility criteria. These waiver programs can provide financial support for various services, including adult day care, housekeeping, assistance with daily personal care, and home modifications.
If you anticipate needing custodial care, you can explore long-term care insurance options to help manage the expenses associated with such care.
Medicare Savings Programs are plans for those with limited resources. How the plans work can differ by state, but all can provide financial assistance with paying Medicare out-of-pocket costs.
Sometimes, caregiving families may obtain financial relief for specific purposes, such as for respite care or to purchase goods and services,
Also, a Medicare supplement (Medigap) plan can offer coverage for
some costs that Medicare does not cover, providing additional financial support for your healthcare needs. Call us if you’d like to explore these Medicare plans!
How can I find a good caregiver?
Medicare offers a useful tool for locating home health agencies. Once you identify a suitable agency nearby, you can use Medicare’s home health agency checklist to assess whether that home health provider can meet your desired level of care.
For an up-to-date evaluation of the quality of care provided by home healthcare providers, your state survey agency maintains detailed reports.
Remember, Medicare permits you to receive care from only one home health agency at a time. If you decide to switch to a different agency, you will need a new referral from your doctor, and it’s essential to inform your previous agency about this change in providers.
Can a family member get paid to be a caregiver?
Medicare does not directly pay family as an in home caregiver.
However, there are some circumstances in which certain Medicaid programs or other state-specific programs might offer compensation to family caregivers. These programs for family members are usually referred to as “Cash and Counseling” or “Consumer-Directed” programs.
In these programs, the person receiving care, who is eligible for Medicaid, can choose their own caregiver, including a family member, and some states allow that caregiver to receive payment for the services provided. The compensation amount and eligibility criteria vary by state, so the family member will need to check with their state’s Medicaid office or Department of Aging for more information.
Family Caregivers in Florida
In Florida, several programs offer compensation to family members who provide non-medical, hands-on assistance for their loved ones. However, eligibility for these programs is not guaranteed, and various factors such as income, savings, marital status, or veteran status can influence eligibility. Even if one meets all the program requirements, there might still be a waiting list for benefits before receiving compensation.
Matthew Claassen
Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.
