Medicare pays for caregivers, however, they must meet certain qualifications in order to be eligible for in-home medical care coverage. As of now, if it is deemed medically necessary for a beneficiary, they are able to use Medicare home health benefits for:
- Part-Time (Intermittent) Skilled Nursing Care
- Physical Therapy
- Occupational Therapy
- Speech-Language
- Pathology Services
- Medical Social Services
- Injectable Osteoporosis Drugs for Women
In order for beneficiaries to receive coverage for in-home care services, they must be deemed homebound by a medical provider. This entails that a patient is unable to leave their house to receive medical care and is typically only able to leave home in infrequent instances for events like religious services. However, if a beneficiary is enrolled in an adult day care program, they are still able to receive home health care. If a Medicare beneficiary was admitted to the hospital or a skilled nursing facility for three or more consecutive days, they are eligible for Medicare-covered home health care through Part A. Medicare Part A, known as Original Medicare’s hospital coverage, will cover home health services for 100 days as long as a beneficiary is due to receive home health care within 14 days of leaving the hospital or nursing facility.
Part B (Medical Coverage)
If a patient was not hospitalized prior to needing home health care, Medicare Part B will cover their services as long as home services are deemed medically necessary by a licensed provider.
Part C (Medicare Advantage Plans) Medicare Advantage (MA) plans, otherwise known as Medicare Part C, work to fill the gaps in standard Medicare coverage and are provided by private insurance companies that are contracted through Medicare.
Since all MA plans include Part A and Part B coverage bundled into one health plan, home health services will be covered exactly as detailed above. However, since MA plans are provided by private health insurance companies, certain plan types may require beneficiaries to seek in-network home health service providers. Beneficiaries should always contact a licensed insurance agent before selecting a home health provider to ensure no added out-of-network expenses.
Part D (Prescription Drug Coverage)
Part D prescription drug coverage is not included in Original Medicare plans and must be added separately by Medicare beneficiaries. Having a Part D plan will help beneficiaries cover any prescription drugs needed during their home health stay. Since prescription drug plans are offered by private health insurers, certain plans may have limitations on which drugs they cover. Prior to filling a prescription, beneficiaries should be sure to check what their plan covers or speak with an insurance agent to learn more.
Medicare Supplement Insurance Plans
Supplemental Medicare plans such as Medigap (MedSupp) assist beneficiaries with out-of-pocket costs that Original Medicare doesn’t cover. Supplement plans may assist beneficiaries with certain home health care costs that aren’t covered by Medicare. However, since these plans are provided by private health insurance companies, they may require beneficiaries to use providers or prescription drugs that are in-network.
Source: Medicare.gov