Caring for an elderly parent or relative is often challenging and time-consuming. In-home healthcare is one excellent option to help reduce the burden on you and your family, but working with a home healthcare agency for the first time can be confusing. It may be especially hard to navigate this process while also dealing with the complexities of Medicare coverage.
Unfortunately, Medicare's home health care rules can be hard to understand. While no single article can cover every coverage detail, this guide will explain some of the basics so you can understand whether your loved one is likely to qualify for home health care coverage with Medicare.
Does Medicare Cover In-Home Care Services?
Medicare covers some in-home care services. Medicare generally will not cover around-the-clock care, live-in personal assistants, or similar services. However, Medicare does many healthcare benefits delivered at home, especially for individuals lacking mobility or with a limited capacity to leave their homes.
These services are relatively wide-ranging and cover everything from nursing care to therapy and social support. However, the services covered will depend on your specific needs and an evaluation by a qualified doctor. For example, Medicare is unlikely to cover personal assistance for bathing, getting dressed, etc., if a doctor doesn't certify that your loved one requires these services.
What Do You Need for Medicare Coverage?
Medicare coverage for in-home care relies on the concept of being "homebound." A homebound individual isn't necessarily incapable of leaving their home, but they can typically only do so with difficulty or assistance. Someone who is homebound may still be mobile, but they generally can't safely travel more than short distances without assistance.
In addition to being certified homebound, Medicare requires that individuals use in-home care services as part of a larger treatment plan. In other words, the services provided must not be indefinite. Instead, they should include therapy, support, or safety services during a recovery period with some expectation of long-term improvement.
What Other Payment Options Are Available?
If Medicare doesn't cover the in-home care that your loved one requires, you may have other options for payment. Aside from paying out of pocket, Medicaid is another option for government funding. Medicaid has less strict rules on coverage, and most state Medicaid programs will cover personal care services for low-income individuals.
You may also want to look into other state-sponsored programs if your loved one requires care that they or you cannot afford. In-home care can be an excellent way to improve your loved one's quality of life while also removing some of the burden and stress of being a primary caregiver, so it's worth exploring your options to find one that works for your situation and budget.Share