Medicare Coverage for Home Health Care

There are several benefits covered under Medicare, each with eligibility requirements that determine the payment or reimbursement amounts you are entitled to. When it comes to paying for home health care, Medicare covers 100% of certain services, while little or nothing of others. Let’s take a look at what in-home services fall under the Medicare benefit and which do not—and how you can pay for home health care if it isn’t covered.

What home health care services are covered for seniors on Medicare?

As a senior on Medicare, you’ll find that your benefit will pay for skilled services as opposed to unskilled.

Skilled care: Medicare pays for short-term services to help you recover from an illness, injury, or hospitalization, or to manage a chronic condition like COPD, heart disease, or diabetes. These skilled services are usually provided by a nurse and/or therapist (physical, occupational, and speech). You’ll need a referral from your doctor and meet eligibility requirements to qualify.

Unskilled care: These non-Medicare services are typically ongoing personal care, household support, and companionship services—such as those from home health aides. Home health aides provide assistance with activities of daily living (ADLs) such as bathing, dressing, light housekeeping, and meal preparation. While these services are essential for helping many seniors continue to live safely and independently at home, you can’t use your Medicare benefit to pay for them.

How can seniors pay for in-home care services not covered by Medicare?

Since Medicare coverage for home health care is limited to certain eligibility requirements for skilled care, most seniors access non-Medicare covered services by paying out of pocket or through a long-term care (LTC) policy. Many home health care agencies are willing to work out a payment plan for those paying privately, or accept payment from your policy. Some companies like BAYADA will help you navigate your LTC benefits by reviewing your current policy, determining eligibility for reimbursement, and automating weekly billing for home care services so you don’t have to. If you or a loved one needs assistance with options for home health care, call (888) 876-0111 today. 

Does Medicare pay for hospice care?

Medicare will cover hospice services if your doctor has determined that you have a life expectancy of six months or less. These end-of-life services are available at home, in a senior living community, skilled nursing facility, or hospital. Like many people, you may prefer to receive end-of-life care services at home, and you can expect all the same comfort and support services you would receive in a hospice residential facility. An interdisciplinary team of hospice professionals provide a range of services including:

• Pain and symptom management
• Medication, supplies, and equipment
• Assistance with personal care
• Nursing, aide, social work, therapy, and physician support
• Short-term respite to relieve caregivers
• Continuous care for acute symptoms

Does Medicare pay for palliative care?

If your doctor determines that you would benefit from palliative care and writes a referral, Medicare will cover the costs.

Palliative care—which is often confused with hospice care—is a health care specialty with the goal to relieve pain and suffering to help you live a better quality of life. Although palliative and hospice care are both considered comfort care, palliative care can be provided at any stage of an illness, as opposed to hospice which is end-of-life care.

Common diagnoses that can benefit from palliative care are:

• ALS
• Stroke
• Alzheimer's disease
• Dementia
• Multiple Sclerosis (MS)
• Chronic liver disease
• HIV/AIDS
• Renal disease
• Kidney failure
• Respiratory (lung) disease
• COPD
• Heart disease
• Congestive heart failure
• Cancer

BAYADA offers comprehensive services and payment options

BAYADA provides a comprehensive array of services, including both Medicare-certified and non-Medicare-covered services. We design a care plan customized to your specific needs, and process referrals quickly to start care as soon as possible. So no matter your needs or where you call home, our compassionate and trained home health care professionals can help you live a better quality of life with safety, comfort, and dignity. Reach out to your local BAYADA office for more information or to set up your home health care arrangements.